Rare Primary Headaches
Rare Primary Headaches
Nummular headache is characterized by a continuous or intermittent head pain that is exclusively felt in an area of the scalp. It was previously known as coin-shaped headache. The affected area should be sharply contoured, fixed in size and shape, round or elliptical and 1–6 cm in diameter. A new review reported on more than 250 cases. Pain is mainly localized in the parietal region and of mild to moderate intensity. Exacerbation of pain is often observed. The affected area can also show additional sensations such as paraesthesia or allodynia. Single cases of bifocal or multifocal nummular headache were described in the literature. As it is a rare disorder, controlled studies on therapy are missing as yet. Gabapentin, tricyclic antidepressants and botulinum toxin might show a sufficient therapeutic response. Single cases of pain amelioration after therapy with neurotropin were reported.
Neuroimaging is warranted in all patients presenting with nummular headache to rule out secondary causes especially pituitary lesions. Nummular headache often subsides after surgical intervention. One case report described a localized calcific hematoma of the scalp as the underlying pathophysiology of a secondary nummular headache. In contrast, nummular headache may also occur postoperatively. After transsphenoidal resection of a pituitary prolactinoma, one patient developed an intermittent nummular headache, which responded to medical treatment with gabapentin.
Nummular Headache
Nummular headache is characterized by a continuous or intermittent head pain that is exclusively felt in an area of the scalp. It was previously known as coin-shaped headache. The affected area should be sharply contoured, fixed in size and shape, round or elliptical and 1–6 cm in diameter. A new review reported on more than 250 cases. Pain is mainly localized in the parietal region and of mild to moderate intensity. Exacerbation of pain is often observed. The affected area can also show additional sensations such as paraesthesia or allodynia. Single cases of bifocal or multifocal nummular headache were described in the literature. As it is a rare disorder, controlled studies on therapy are missing as yet. Gabapentin, tricyclic antidepressants and botulinum toxin might show a sufficient therapeutic response. Single cases of pain amelioration after therapy with neurotropin were reported.
Neuroimaging is warranted in all patients presenting with nummular headache to rule out secondary causes especially pituitary lesions. Nummular headache often subsides after surgical intervention. One case report described a localized calcific hematoma of the scalp as the underlying pathophysiology of a secondary nummular headache. In contrast, nummular headache may also occur postoperatively. After transsphenoidal resection of a pituitary prolactinoma, one patient developed an intermittent nummular headache, which responded to medical treatment with gabapentin.
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