, Volume 10, Issue 3, pp 215-217
Date: 24 Feb 2009

Nummular headache associated to arachnoid cysts

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Introduction

Nummular headache (NH) is a chronic pain felt in a coin-shaped or elliptical area on the head surface [1]. Though currently classified as a primary headache, a case of NH secondary to a tentorial meningioma has been published recently [2]. We report two patients with NH as the only symptom of underlying arachnoid cysts (AC).

Case 1

A 52-year-old woman suffered a subarachnoid haemorrhage (SH) that caused cephalalgia without focal neurological abnormality. A four-vessel angiography revealed no vascular malformations but a right posterior parietal AC was found. High blood pressure was demonstrated and treated. Shortly after the SH, she started feeling a sore pain over a circumscribed area of the right parieto-occipital scalp (Fig. 1a), where a 2.5 cm, coin-shaped area of tenderness and dysesthesia was detected, while neurological examination was normal. A MRI confirmed a 3 × 2.5 × 3 cm parieto-occipital AC (Fig. 1b). Several treatments, including gabapentin, indomethacin and ami