E-Pearl of the Week: Nummular Headache

December 28, 2012

Share:

E–Pearl of the Week

Interested in submitting an e–Pearl? Click here!

Brought to you by the Resident and Fellow Section of Neurology®.

December 26, 2012

Nummular Headache

A nummular headache is a primary headache disorder characterized by cranial / terminal branch neuralgia without underlying structural lesion. The pain is characteristically of mild to moderate intensity and restricted to a 1 to 6 cm well-circumscribed coin-shaped region over the head, usually over the parietal region. Most patients will have hypoesthesia or stimulus-induced paresthesias in the affected area. Symptoms tend to be unilateral and do not migrate or radiate. Autonomic symptoms are typically absent. Nummular headache is thought to be a neuralgia of a distal terminal branch of the scalp or epicranial tissue; however this has yet to be proven. Symptoms do not always require treatment, but when they do, they often do not respond to local anesthetic infiltration. Oral non-steroidal antiinflammatory medications, neuromodulators, and botulinum toxin injections have been tried in cases requiring treatment.

References

  1. Pareja JA, Caminero AB, Serra J et al. Numular headache: a coin-shaped cephalgia. Neurology 2002;58:1678-1679.
  2. Pareja JA, Montojo T, Alvarez M. Nummular headache update. Curr Neurol Neurosci Rep 2012;12:118-124.

Submitted by: Robert Altman MD, FRCPC

Disclosure: Dr. Altman reports no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit www.neurology.org and click on the link to the Resident and Fellow Pages. Click here to visit the E–Pearl of the Week Archive.

Click here to listen to this week's Neurology® Podcast.