E-Pearl of the Week: Nummular Headache

December 28, 2012


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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.


  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.

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