A nummular headache is a rare type of primary headache disorder characterized by pain localized to a small, coin-shaped area on the head.
While relatively rare and potentially underdiagnosed, nummular headaches present with some distinct characteristics. Only a few hundred cases have been documented in medical literature.
Key Features of Nummular Headaches:
- Localized Pain: The most defining feature is the pain being confined to a small, circular area, typically 2-6 cm in diameter, resembling the size of a coin.
- Pain Characteristics: The pain can vary in intensity and nature, ranging from mild to severe and described as constant, throbbing, stabbing, or pressure-like.
- Location: While the pain can occur anywhere on the head, it often remains fixed in the same location for each headache episode.
- Frequency: The frequency of nummular headaches can vary from occasional episodes to daily occurrences.
- Possible Underlying Cause: Although typically considered a primary headache disorder, secondary causes, such as skin or bone lesions, should be ruled out.
Diagnosis
Diagnosis is primarily clinical, based on patient history and a neurological examination. Diagnostic criteria include:
- Headache pain is felt exclusively in a circular or elliptical area of 1-5 cm2
- Pain has been present for longer than 3 months, with headache attacks occurring on more days than not
- Pain can be continuous, intermittent, or both
- The headache doesn't have features that point to another headache disorder
Treatment
Treatment options vary depending on the severity and frequency of the headaches. Possible treatment options include:
- Pain relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen.
- Triptans: Medications often used for migraine headaches, can be useful for some nummular headache sufferers.
- Other medications: Tricyclic antidepressants, gabapentin, or onabotulinumtoxinA (Botox) injections can be used to manage the headache.
- Local Injections: Local anesthetic or corticosteroid injections into the affected area.
In conclusion, a nummular headache is a distinct primary headache disorder characterized by localized, coin-shaped pain on the head and warrants evaluation to rule out secondary causes and implement appropriate management strategies.
