Nummular headache: Peripheral or central? One case with reappearance of nummular headache after focal scalp was removed, and literature review

Dai, Wei; Yu, Shengyuan; Liang, Jingyao; Zhang, Mingjie

doi:10.1177/0333102412474504

Cited by 28 publications

(40 citation statements)

References 39 publications

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“…The mean duration of headache in our study was 24.17 months which is shorter than the figure of 6.4 years available from the published English literature. [6] We postulate that a larger study extending for a longer period might well reduce this discrepancy. Regarding the clinical features, the location (parietal) and diameter and shape (circular) proved to be similar to that described in the international literature.…”

Section: Discussionmentioning

confidence: 98%

“…In view of its relative rarity, for this study, we compared the epidemiological and clinical features of our patients with those appearing in the literature review of all published cases of NH by Dai et al . [6] [Table 1]. Those authors studied a total of 238 cases from the 30 published English studies from 2002 to 2012 and had comprehensively described their clinical and demographic characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, infiltration of local anesthetics did not relieve pain in the majority of cases. A few interesting case descriptions such as large diameter NHs with bitrigeminal hyperalgesia[11] and a case of NH in which pain recurred even after focal scalp resection of the affected area[6] have also favored a central causation of NH. In this regard, it is interesting that one of our patients also had preexisting trigeminal neuralgia.…”

Section: Discussionmentioning

confidence: 99%

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Nummular headache: Clinico-epidemiological features in South Indian population

Rammohan

Mundayadan

Mathew

2016

Journal of Neurosciences in Rural Practice

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Context:Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2–6 cm in diameter.Aims:The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature.Settings and Design:A prospective, observational study conducted in a tertiary care center.Materials and Methods:Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient.Results:A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36–60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia.Conclusion:Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Nummular headache: Clinico-epidemiological features in South Indian population

Rammohan

Mundayadan

Mathew

2016

Journal of Neurosciences in Rural Practice

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“…Nummular headache, considered to be a headache of peripheral origin, is characterized by pain in a rounded, oval, or elliptical region in the head measuring 1 to 6 cm in diameter. The quality and intensity of pain are variable .…”

Section: Primary Headachesmentioning

confidence: 99%

Nerve Block for the Treatment of Headaches and Cranial Neuralgias – A Practical Approach

et al. 2015

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The nerve block can be used in primary (migraine, cluster headache, and nummular headache) and secondary headaches (cervicogenic headache and headache attributed to craniotomy), as well in cranial neuralgias (trigeminal neuropathies, glossopharyngeal and occipital neuralgias). In some of them this procedure is necessary for both diagnosis and treatment, while in others it is an adjuvant treatment. The block of the greater occipital nerve with an anesthetic and corticosteroid compound has proved to be effective in the treatment of cluster headache. Regarding the treatment of other headaches and cranial neuralgias, controlled studies are still necessary to clarify the real role of peripheral nerve block.

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“…The debate about the underlying pathogenesis of NH mainly focuses on whether NH originates from the peripheral or central nervous system. Given the typical topographic features, frequently reported sensory dysfunction and decreased pressure pain threshold restricted to the symptomatic area, a hypothesis of a dysfunctional peripheral sensory nerve has been proposed . However, some evidence supports the central origin of NH, including the unsatisfactory effectiveness of local nerve blocks, painful areas extending across the midline, and head pain involving more than 1 area .…”

Section: Discussionmentioning

confidence: 99%

Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review

Jiang

Liu

et al. 2019

Headache

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Objective To report 2 new nummular headache (NH) cases and review the clinical features and management of NH. Background NH is a coin‐shaped headache with a fixed shape and size. Since the first case series was reported by Pareja, approximately 300 cases have been reported. However, the latest treatment status and pathogenesis of NH remain unclear. Methods Two new NH cases with improved symptomatic responses to metoprolol were reported. We also conducted a narrative review of cases published in English aiming to provide the newest information about the clinical features and management of NH. Results Two NH patients with skin depressions within the painful area experienced significantly improvement with metoprolol. The literature review showed that NH was mainly moderate‐to‐severe in 77.8% (186/239) of the patients. Sensory dysfunction and focal trophic changes were reported in 47.8% (149/312) and 3.8% (12/312) of the patients, respectively. Gabapentin was the most commonly used and effective prophylactic, with a responder rate of 67.9% (55/81). Botulinum toxin type A was used for refractory NH, with an effective rate of 81.8% (9/11). Ten patients from the previous studies were prescribed β‐adrenergic blockers without any relief, and none of them reported focal tropic changes. Conclusions NH can be a disabling headache in more than half of identified patients and requires medical intervention. As with the previous treatment recommendations, gabapentin was the most commonly used prophylactic with a good response. Our cases suggested that β‐adrenergic blockers could be a therapeutic option for NH patients with focal trophic changes within the areas.

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Nummular headache: Peripheral or central? One case with reappearance of nummular headache after focal scalp was removed, and literature review

Abstract: Our case and evidence from the literature review support the peripheral mechanism of nummular headache. Nummular headache might be a local pain disorder stemming from terminal branches of a sensory nerve and could induce peripheral sensitization in one or several primary sensory neurons.

Cited by 28 publications

References 39 publications

Nummular headache: Clinico-epidemiological features in South Indian population

Nummular headache: Clinico-epidemiological features in South Indian population

Nerve Block for the Treatment of Headaches and Cranial Neuralgias – A Practical Approach

Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review

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