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Brought to you by the Resident and Fellow Section of Neurology®.
December 26, 2012
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.
Submitted by: Robert Altman MD, FRCPC
Disclosure: Dr. Altman reports no disclosures.
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