Nummular HeadacheWhat on earth is Nummular Headache? This is a rare condition. I have diagnosed two cases in the last year and in 5 years have seen about 6 cases in total. This means that in my own practice I see this disorder in less than 0.5% of headache patients. Nummular is from the Greek word for "coin". The area of pain never changes and is circular or oval in shape - a coin-shaped area of pain. The area can be sensitive to touch and combing or brushing hair can be painful. It can affect people of any age - I have young women, older men and middle aged women among my own cases. Most people have constant pain restricted to this one well-defined area. This pain can be pressure-like or even itchy! There may be some stabbing pains on top of the background ache. Usually pain is continuous, but about one third of people will become pain-free. Some people will have had the pain for many years, and be diagnosed as tension-type headache, before a diagnosis is made. When I suspect the diagnosis I usually try and test scalp sensation with a sharp pin. The affected area will have abnormal sensation - the area may be hyper-sensitive, but reduced sensation occurs just as often. What can be done about it and is it serious?Most people require reassurance, but in some the pain is severe, and anti-inflammatory medication like Indomethacin is recommended. I also have used Gabapentin.The condition is not commonly associated with underlying serious brain disorders. There is one case of a dilated external carotid artery in a patient with Marfan's Syndrome and another associated with a small benign meningioma. One very recent report identified an underlying benign overgrowth of skull bone. Some patients, including one of my own, have a small area of baldness over the site of pain. Whether this is due to underlying scalp disease or is due to the patient rubbing the affected area is not known. Please don't be afraid of this headache - it is not serious, but the nuisance factor may justify a short course of medication. There are some cases who have responded to injections of Botulinum Toxin (Botox or Dysport), but I have no experience of this and there are no scientific trials of its use. A TENS (Transcutaneous Electrical Nerve Stimulator) machine has given one North American patient relief of pain after a few days of use.
ReferencesPareja JA et al. A coin shaped cephalalgia. Neurology 2002;58:1678-9 (free abstract).Pareja JA et al A prospective series of 14 cases. Headache 2004;44:611-4 (free abstract). Z Tayeb et al Successful NH treatment with TENS. Cephalalgia 2008;28:897-8 (free abstract). A Guillem et al. Nummular headache secondary to an intracranial mass lesion. Cephalalgia 2007;27:943-4 (free abstract) Garcia-Pastor et al Fusiform aneurysm of the scalp: an unusual cause of focal headache in Marfan's Syndrome. Headache 2002;42:908-10 (free abstract).
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