Abstract
Nummular headache is characterized by head pain exclusively felt in a rounded or elliptical area, typically 1 to 6 cm in diameter. The pain remains confined to the same symptomatic area, which does not change in shape or size with time. The symptomatic area may be localized in any part of the head but mostly in the parietal region. Rarely, the disorder may be multifocal, each symptomatic area keeping all the characteristics of nummular headache. The pain is generally mild or moderate, commonly described as oppressive or stabbing, and lasting minutes, hours, or days, with a remitting or unremitting pattern. Superimposed on the baseline pain, there may be spontaneous or triggered exacerbations. During and between symptomatic periods, the affected area may show variable combinations of hypoesthesia, dysesthesia, paresthesia, tenderness, and trophic changes. Nummular headache emerges as a primary disorder with a clear-cut clinical picture developed in a unique topography.
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Pareja JA, Caminero AB, Serra J, et al. Numular headache: a coin-shaped cephalgia. Neurology. 2002;58:1678–9.
International Headache Society. The international classification of headache disorders, 2nd edition. Cephalalgia. 2004;24 Suppl 1:1–160.
Pareja JA, Pareja J, Barriga FJ, et al. Nummular headache. A prospective series of 14 new cases. Headache. 2004;44:611–4.
Barriga FJ, Hernández T, Pardo J, et al. Cefalea numular: serie prospectiva de 20 nuevos casos. Neurología. 2004;19:463–555 (abstract).
Guerrero AL, Martín-Polo J, Tejero MA, et al. Representación de la cefalea numular en una consulta general de neurología. Neurología. 2008;23:474.
Cuadrado ML. Cefalea numular. In: Mateos V, editor. Migraña y otras cefaleas. Barcelona: Elsevier España; 2011. p. 323–44.
Cortijo E, Guerrero Peral AL, Herrero-Velázquez S, et al. Nummular headache: clinical features and therapeutic experience in a series of 30 new cases. Rev Neurol. 2011;52:72–80.
Evans R, Pareja JA. Nummular headache. Headache. 2005;45:164–5.
Evans EW. Case studies of uncommon headaches. Neurol Clin. 2006;24:347–62.
Cohen L. Nummular headache: what denomination? Headache. 2005;45:1417–8.
Dach F, Speciali J, Eckeli A, et al. Nummular headache: three new cases. Cephalalgia. 2006;26:1234–7.
Zhu KY, Huang Y, Zhong SS, et al. Nummular headache: 21 new cases and therapeutic results. Zhonghua Yi Xue Za Zhi. 2008;88:2935–7.
Guillem A, Barriga FJ, Giménez-Roldán S. Nummular headache associated to arachnoid cysts. J Headache Pain. 2009;10:215–7.
Moon J, Ahmed K, Garza I. Case series of sixteen patients with nummular headache. Cephalalgia. 2010;30:1527–30.
•• Cuadrado ML, Valle B, Fernández de las Peñas, et al.: Bifocal nummular headache: the first three cases. Cephalalgia 2009, 29:583-6. This is the first communication of multifocal nummular headache with description of the chronology of all symptomatic areas.
• Ruscheweyh R, Buchheister A, Gregor N, et al.: Nummular headache: six new cases and lancinating pain attacks as possible manifestation. Cephalalgia. 2010, 30:249-53. In this article a new feature of NH is described: short-lasting painful attacks in the symptomatic area.
Porta-Etessam J, Lapeña T, Cuadrado ML, et al. Multifocal nummular headache with trophic changes. Headache. 2010;50:1612–3.
Rocha-Filho PA. Nummular headache: two simultaneous areas of pain in the same patient. Cephalalgia. 2011;31:874.
Guerrero AL, Cuadrado ML, García-García ME, et al. Bifocal nummular headache: a series of 6 new cases. Headache. 2011;51:1161–6.
Trucco M. Nummular headache: another headache treated with gabapentine. J Headache Pain. 2007;8:137–8.
Grosberg BM, Solomon S, Lipton RB. Nummular headache. Curr Pain Headache Rep. 2007;11:310–2.
Bao YQ, Huang Y, Tian XL, et al.: Nummular headache. Eight new cases and therapeutic results in China. Cephalalgia 2007, 27:688 (abstract).
•• Pareja JA, Cuadrado ML, Fernández de las Peñas C, et al.: Nummular headache with trophic changes inside the painful area. Cephalalgia 2008, 28:186-90. Local trophic changes may be a clinical feature of NH. Together with pain and sensory disturbances, they could represent a restricted form of complex regional pain syndrome. This should be taken as a possible evolution of the underlying morbid process of NH.
Kraya T, Gaul C. Münzkopfschmerz: eine bislang wenig bekannte kopfschmerzkrankung. Nervenartz. 2008;79:202–5.
Tayeb Z, Hafeez F, Shafig Q. Successful treatment of nummular headache with TENS. Cephalalgia. 2008;28:897–8.
Dusitanond P, Young W. Botulinum toxin type A’s efficacy in nummular headache. Headache. 2008;48:1379.
Monzillo PH, Lima Neto MM, Sanvito WL, et al. Cefaléia numular. Relato de caso. Arq Neuropsiquiatr. 2004;62:903–5.
Grosberg BM, Solomon S, Bigal ME, et al.: Nummular headache and the International Classification of Headache Disorders (ICHD-2). Neurology 2006, 66 (Suppl 2): A178 (abstract).
•• Mathew NT, Kailasam J, Meadors L: Botulinum toxin type A for the treatment of nummular headache: four case studies. Headache 2008, 48:442-7. This is a very important report because a peripheral therapeutic approach with botulinum toxin A injected in the symptomatic area seems to be a promising therapy for NH.
Álvaro LC, García JM, Areitio E. Nummular headache: a series with symptomatic and primary cases. Cephalalgia. 2009;29:379–83.
Giffin NJ: Nummular headache: a case series from a district general hospital. [abstract PO255] Presented at the 14th Congress of the International Headache Society. Philadelphia, PA; September 10-13, 2009.
Baldacci F, Nuti A, Lucetti C, et al. Nummular headache dramatically responsive to indomethacin. Cephalalgia. 2010;30:1151–2.
Trucco M, Mainardi F, Perego G, et al. Nummular headache: first Italian case and therapeutic proposal. Cephalalgia. 2006;26:354–6.
Guillem A: Nummular headache precipitated by coughing and sexual activity. Cephalalgia 2009, 29 (Suppl 1): 161 (abstract).
Robbins MS, Grosberg BM. Menstrual-related nummular headache. Cephalalgia. 2010;30:507–8.
Pareja JA, Pareja J. Nummular headache: diagnosis and treatment. Expert Rev Neurotherapeutics. 2003;3:289–92.
Dabscheck G, Andrews PI. Nummular headache associated with focal hair heterochromia in a child. Cephalalgia. 2010;30:1403–5.
Ray BS, Wolff HG. Experimental studies on headache: pain-sensitive structures of the head and their significance in headache. Archives Surgery. 1940;41:813–56.
Penfield W, McNaughton F. Dural headache and innervation of the dura matter. Archives of Neurology & Psychiatry. 1940;44:43–75.
Fernández-de-las-Peñas C, Cuadrado ML, Barriga FJ, et al. Pericranial tenderness is not related to nummular headache. Cephalalgia. 2007;27:182–6.
Fernández-de-las Peñas C, Cuadrado ML, Barriga FJ, et al. Local decrease of pressure pain threshold in nummular headache. Headache. 2006;46:1195–8.
Cuadrado ML, Valle B, Fernández-de-las-Peñas C, et al. Pressure pain sensitivity of the head in patients with nummular headache: a cartographic study. Cephalalgia. 2010;30:200–6.
Dostrovsky JO, Craig AD. Ascending projection systems. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 5th ed. Philadelphia: Elsevier; 2006. p. 187–203.
Kosaras B, Jakubowski M, Kainz V, et al. Sensory innervation of the calvarial bones of the mouse. J Comp Neurol. 2009;515:331–48.
Thompson PD, Thomas PK. Clinical patterns of peripheral neuropathy. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1137–61.
•• Fernández-de-las Peñas C, Peñacoba-Puente C, López-López A, et al.: Depression and anxiety are not related to nummular headache. J Headache Pain 2009, 10:441-5. In this article the authors demonstrate the organic nature of NH. NH was not associated with depression and anxiety, since patients with NH showed similar mood states to those of healthy controls. Furthermore, in patients with NH neither depressive symptoms nor anxiety levels were related to headache clinical parameters.
Pareja JA, Pareja J, Yangüela J. Nummular headache, trochleitis, supraorbital neuralgia, and other epicranial headaches and neuralgias: the epicranias. The Journal of Headache and Pain. 2003;4:125–31.
García-Pastor A, Guillem-Mesado A, Salinero-Paniagua J, et al. Fusiform aneurysm of the scalp: an unusual cause of focal headache in Marfan syndrome. Headache. 2002;42:908–10.
Guillem A, Barriga FJ, Giménez-Roldán S. Nummular headache secondary to an intracranial mass lesion. Cephalalgia. 2007;27:943–4.
Pareja JA, Cuadrado ML, Fernández de las Peñas C, et al. Epicrania fugax: an ultrabrief paroxysmal epicranial pain. Cephalalgia. 2008;28:257–63.
Pareja JA, Ruiz J, de Islas C, et al. Idiophathic stabbing headache (Jabs and jolts syndrome). Cephalalgia. 1996;16:93–6.
Pareja JA, Sjaastad O: Primary Stabbing Headache. In Handbook of Clinical Neurology. Vol 97 (3rd series) Headache. Edited by Nappi G, Moskowitz MA. Headache. Amsterdam: Elsevier BV; 2010: pp 453-457.
Fernández de las Peñas C, Cuadrado ML, Arendt-Nielsen L, et al. Side-to-side differences in pressure pain thresholds and pericranial tenderness in strictly unilateral migraine. Eur J Neurol. 2008;15:162–8.
Fernández de las Peñas C, Ge HY, Cuadrado ML, et al. Bilateral pressure pain sensitivity mapping of the temporalis muscle in chronic tension-type headache. Headache. 2008;48:1067–75.
Fernández de las Peñas C, Madelaine P, Cuadrado ML, et al. Pressure pain sensitivity mapping of the temporalis muscle revealed bilateral pressure hyperalgesia in patients with strictly unilateral migraine. Cephalalgia. 2009;29:670–6.
Pareja JA, Caminero AB. Supraorbital neuralgia. Current Pain and Headache Reports. 2006;10:302–5.
Sjaastad O, Pareja JA, Zuckerman E, et al. Trigeminal neuralgia. Clinical manifestations of first division involvement. Headache. 1997;37:346–57.
Pareja JA, Cuadrado ML, Caminero AB, et al. Duration of attacks of first division trigeminal neuralgia. Cephalalgia. 2005;25:305–8.
Seo MW, Park SH. Botulinum toxin treatment in nummular headache. Cephalalgia. 2005;25:991 (Abstract).
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Pareja, J.A., Montojo, T. & Álvarez, M. Nummular Headache Update. Curr Neurol Neurosci Rep 12, 118–124 (2012). https://doi.org/10.1007/s11910-011-0247-2
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DOI: https://doi.org/10.1007/s11910-011-0247-2