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García-Iglesias C, González-Celestino A, Sierra Mencía Á, González Osorio Y, Recio García A, Martínez-Badillo C, Echavarría Íñiguez A, Varona-Galán B, García-Azorín D, Guerrero-Peral ÁL. Long-term outcomes of nummular headache: A series of 168 patients and 1198 patient-years of follow-up. Cephalalgia 2023; 43:3331024231201576. [PMID: 37728578 DOI: 10.1177/03331024231201576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Since the first description of nummular headache (NH), more than 500 cases have been described, delineating its clinical phenotype and response to treatment. However, data on the natural history of NH and outcomes during long-term follow-up are not currently available. The present study aimed to describe the long-term outcomes and follow-up of a large series of patients with NH. METHODS A descriptive observational ambisective study with a series of cases was conducted. The study population included adult patients with primary NH and a minimum of 12 months of follow-up. Demographic variables, previous medical history, clinical phenotype, diagnosis and treatment of NH, temporal pattern, and long-term evolution were analysed. RESULTS In total, 168 patients were enrolled and followed for a median [interquartile range (IQR)] of 80.5 (55-118.5) months. The temporal pattern after NH onset was chronic in 67.9% and, at diagnosis, the median (IQR) number of pain days per month was 20 [10-30] days with 138 (82.1%) patients with ≥8 days of pain per month. Preventive treatment was needed by 112 (66.7%) patients. The most frequently used drugs were gabapentin (69/112; 61.6%), onabotulinumtoxinA (38/112; 33.9%), amitriptyline (31/112; 27.7%) and lamotrigine (21/112; 18.7%). Response to preventive treatment was at least partial in 91/112 (81.3%) patients. At the end of follow-up, 81 (48.2%) patients had inactive NH. Of patients with active NH, the median (IQR) number of headache days per month was 3 (1-12) days and patients had ≥8 days of pain in 35 (20.8%) cases. CONCLUSIONS Long-term outcomes of NH were positive in most patients. After a median of 6.7 years of follow-up, 48% of cases were inactive. Two-thirds of patients required preventive treatment, and 80% of them were treatment-responsive. In NH cases that remained symptomatic, the headache frequency was lower, and the proportion of patients with chronic NH decreased from 68% to 11%.
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Affiliation(s)
| | | | - Álvaro Sierra Mencía
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Andrea Recio García
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - Berta Varona-Galán
- Pneumology Department, Complejo Hospitalario Universitario, A Coruña, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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Tereshko Y, Dal Bello S, Lettieri C, Belgrado E, Merlino G, Gigli GL, Valente M. Nummular headache: a case report of remission following ketogenic diet and botulinum toxin type A injections. Front Neurol 2023; 14:1200907. [PMID: 37273713 PMCID: PMC10235448 DOI: 10.3389/fneur.2023.1200907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Nummular headache is an unusual facial pain disorder with no evidence-based therapy recommendations. The ketogenic diet is an alternative therapy that demonstrated to be effective in migraineurs, but it was never used in the setting of nummular headache. We describe a 58-years old female patient with nummular headache successfully treated with a 6-months ketogenic diet and botulinum toxin type A injections. Ketogenic diet could be an effective alternative/complementary therapy in nummular headache patients although more studies are needed to confirm our results.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Simone Dal Bello
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Christian Lettieri
- Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Enrico Belgrado
- Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Giovanni Merlino
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
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Abstract
BACKGROUND Nummular headache and epicrania fugax are two primary headaches that fall under the heading of epicranial headaches. METHODS This article reviews the epidemiological and clinical features of nummular headache and epicrania fugax, proposed pathogenic mechanisms and state-of-the-art management, according to the literature. RESULTS AND CONCLUSIONS Nummular headache and epicrania fugax are generally viewed as rare headache disorders, but no population-based epidemiological data are available. Nummular headache is characterized by continuous or intermittent head pain, which remains circumscribed in a round or oval area of the scalp, typically one to six centimeters in diameter. Epicrania fugax manifests with brief paroxysms of pain that move along the surface of the head, following a linear or zigzag trajectory through different nerve territories. Nummular headache and epicrania fugax are mostly primary headaches, but some secondary cases have been reported. The pathogenesis of these headaches is not fully understood. Nummular headache could probably originate in epicranial tissues or adjacent intracranial structures, while the origin of epicrania fugax could be extracranial or intracranial. Diagnostic assessment requires careful examination of the symptomatic areas. Underlying disorders should be excluded by additional investigations, including neuroimaging and appropriate blood tests. No controlled clinical trials have been conducted in nummular headache or epicrania fugax. Analgesics and anti-inflammatory drugs, botulinum toxin and gabapentin are currently the most recommended treatment options for nummular headache. In epicrania fugax, the most used treatments are gabapentin, lamotrigine, and other antiseizure medications.
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Affiliation(s)
- María-Luz Cuadrado
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Treatment of Primary Nummular Headache: A Series of 183 Patients from the NUMITOR Study. J Clin Med 2022; 12:jcm12010122. [PMID: 36614923 PMCID: PMC9821628 DOI: 10.3390/jcm12010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Nummular headache (NH) is a primary headache characterized by superficial coin-shaped pain. NUMITOR (NCT05475769) is an observational study evaluating the responder rate of preventive drugs in NH patients. The treatment response was assessed between weeks 8 and 12 compared with the baseline. Patients were included between February 2002 and October 2022. Demographic and clinical variables were assessed; treatment response was estimated by 50%, 30%, and 75% responder rates and treatment discontinuation due to inadequate tolerability. A total of 183 out of 282 patients fulfilled eligibility criteria and completed the study. Patients were aged 49.5 (standard deviation (SD): 16.8) years, and 60.7% were female. NH phenotype was a parietal circular pain of four centimeters' diameter, moderate intensity, and oppressive quality. At baseline, patients had 25 (interquartile range) pain days per month. Preventive treatment was used by 114 (62.3%) patients. The highest 50% and 75% responder rates corresponded to onabotulinumtoxinA (62.5%, 47.5%), followed by gabapentin (43.7%, 35.2%). Oral preventive drugs were not tolerated by 12.9-25%. The present study provides class IV evidence of the effectiveness of oral preventive drugs and onabotulinumtoxinA in the treatment of primary NH. OnabotulinumtoxinA was the most effective and best-tolerated drug, positioning it as first-line treatment of NH.
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López‐Bravo A, Oliveros‐Cid A, Mínguez‐Olaondo A, Cuadrado ML. Nummular headache responsive to anti‐calcitonin gene‐related peptide monoclonal antibodies in a patient with migraine. Headache 2022; 62:1063-1066. [DOI: 10.1111/head.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Alba López‐Bravo
- Department of Neurology Hospital Reina Sofía Tudela Navarra Spain
- Aragon Institute for Health Research (IIS Aragon) Zaragoza Spain
| | | | - Ane Mínguez‐Olaondo
- Neurology Department Donostia University Hospital‐OSAKIDETZA San Sebastián Spain
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud Donostia Spain
- Department of Medicine, Faculty of Health Sciences University of Deusto Bilbao Spain
- Neuroscience Area, Biodonostia Research Institute San Sebastián Spain
| | - María Luz Cuadrado
- Headache Unit, Department of Neurology Hospital Clínico San Carlos Madrid Spain
- Departmente of Medicine, School of Medicine Universidad Complutense Madrid Spain
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Kulich M, Setzen M, Doherty J. Comprehensive Management of Headache for the Otolaryngologist: A Summary. Otolaryngol Clin North Am 2022; 55:e1-e8. [PMID: 35987560 DOI: 10.1016/j.otc.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Otolaryngologists will frequently encounter patients with head and facial pain. The headache may be a primary disorder or a symptom of a secondary pathology. Understanding diagnostic criteria and the autonomic and otologic manifestations of primary headaches is imperative for accurate diagnosis and treatment. This article summarizes key points in the issue "Comprehensive Management of Headache for the Otolaryngologist" and can be used as a cursory reference.
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Affiliation(s)
- Marta Kulich
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, 1537 Norfolk Street, Suite 5800, Los Angeles, CA 90033, USA.
| | | | - Joni Doherty
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California
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Ikram H, Vakil H, Zipperer K, Fang X, Jan Q, Islam J, Rai P, Thottempudi N. The Tricky Diagnosis of Nummular Headaches: Description of Two Cases and Literature Review. Cureus 2022; 14:e25043. [PMID: 35719810 PMCID: PMC9199569 DOI: 10.7759/cureus.25043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
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Zhou S, Badash I, Doherty JK. Nummular and Side-locked Headaches for the Otolaryngologist. Otolaryngol Clin North Am 2022; 55:697-706. [PMID: 35490038 DOI: 10.1016/j.otc.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Side-locked headaches are a common symptom having a wide-ranging differential. Unchanging in laterality, these headaches can represent neuralgias, trigeminal autonomic cephalgias, ophthalmologic disorders, otolaryngologic and craniofacial disorders, vascular disorders, and malignancy. In rarer situations, they have presented secondary to neurosurgical or dermatologic considerations. Loss of cranial nerves and visual changes warrant additional evaluation.
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Affiliation(s)
- Sheng Zhou
- LAC+USC Medical Center Otolaryngology Department, 1200 North State Street, Suite A2E, Los Angeles, CA 90033, USA.
| | - Ido Badash
- LAC+USC Medical Center Otolaryngology Department, 1200 North State Street, Suite A2E, Los Angeles, CA 90033, USA
| | - Joni K Doherty
- USC Caruso Department of Otolaryngology Head and Neck Surgery, 1450 San Pablo Street #5100, Los Angeles, CA 90033, USA
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Lax DN, Hershey AD, Kabbouche MA, Kacperski J. Nummular headache in children: A case series and systematic literature review. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221091782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Nummular headache is a rare primary headache disorder potentially disabling and refractory to treatment. Of over 300 reported cases, only 9 are children. Design/Methods: We searched our institutional database and PubMed for “nummular headache” and synonyms and evaluated select articles from reference lists of substantial reviews. Results: Seven children were identified from our institution and nine from 107 unique publications. Mean age at onset was 9.7 and 11.9 years in our cohort and the literature, respectively, with a female:male ratio of 2:1. Location and quality varied, and allodynia was reported in five. Frequency ranged from every other week to continuous. Imaging was normal except in four cases. Migraine was often comorbid. Published cases were frequently refractory to treatment whereas four of our cohort improved with therapy for comorbid migraine. Conclusions: Nummular headache is rarely reported in children. We describe characteristics of seven new and nine previously published pediatric cases.
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Affiliation(s)
- Daniel N Lax
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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García-Iglesias C, Martínez-Badillo C, García-Azorín D, Trigo-López J, Martínez-Pías E, Guerrero-Peral ÁL. SECONDARY NUMMULAR HEADACHE: A NEW CASE SERIES AND REVIEW OF THE LITERATURE. PAIN MEDICINE 2021; 22:2718-2727. [PMID: 34022054 DOI: 10.1093/pm/pnab174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nummular Headache (NH) is defined in the International Classification of Headache Disorders (ICHD) by the presence of localized pain circumscribed to a small round area of the scalp, not better accounted by any other diagnosis. As in many other primary headache disorders, secondary cases might occur. To date, 13 secondary cases have been published. We aim to present a long series of secondary NH and review the literature of symptomatic NH. PATIENTS AND METHODS Retrospective analysis of an observational prospective cohort in a headache unit located in a tertiary hospital. We included patients that fulfilled ICHD criteria and were attributed to a secondary cause. We describe the clinical characteristics, the underlying causes, and the response to treatment. RESULTS We included 274 NH patients, 8 of them (2.9%) were considered secondary. In 1 patient the underlying cause was subcutaneous, as for 6 cases the lesion was located in the bone (two hemangiomas, 1 osteoma, 3 different types of cysts), and in one was intracranial but closely related with internal diploe (cavernoma). Among our patients with secondary NH, a preventive therapy was not always needed and, when required, gabapentin or onabotulinumtoxinA were used with positive response. CONCLUSION Secondary NH phenotype overlaps primary NH. Therefore, we recommend routine imaging study in every NH patient. Concerning treatment, it was not necessary to remove the underlying lesion to control the pain and many cases responded to the same prophylactics as primary NH cases.
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Affiliation(s)
| | | | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Javier Trigo-López
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Enrique Martínez-Pías
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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11
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Chavarría-Miranda A, Guerrero ÁL, Talavera B, Martínez-Pías E, Trigo-López J, Sierra Á, García-Azorín D. Linear Headache: A Novel Entity or a Variant of Nummular Headache? Clinical Characteristics and Treatment Response in a Series of 16 Patients. PAIN MEDICINE 2021; 22:1158-1166. [PMID: 33723599 DOI: 10.1093/pm/pnaa436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Linear headache has been recently described as an episodic or chronic unilateral pain distributed along a fixed linear trajectory, which combines some characteristics of epicrania fugax and nummular headache. The aim of this study was to describe the clinical characteristics and therapeutic response of a series of 16 new patients. DESIGN This is an observational study with a series of cases. SETTING The study period encompassed June 2014 to June 2019. Demographic, clinical, and therapeutic response data were recorded. METHODS We included all consecutive patients who presented pain with the following characteristics: sharply contoured, fixed in size and shape, with linear shape, without movement along a trajectory, and not circumscribed to the territory of any nerve. RESULTS Twelve patients were women, and four were men. The mean age at onset was 40.1 years. Pain was described as pressing in seven patients, burning in five, and electric or stabbing in two each. Symptomatic treatment had been used by 13 patients (81.2%), with analgesics being the most frequent treatment used. Thirteen patients received preventive treatment. The response to oral medications and anesthetic blockade was insufficient. OnabotulinumtoxinA was used in six cases, with an optimal (>75%) response observed in half. CONCLUSION Linear headache appears to be a distinct headache syndrome from epicrania fugax or nummular headache. Preventive treatment is often required. The drug with the best response was onabotulinumtoxinA.
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Affiliation(s)
- Alba Chavarría-Miranda
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángel L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Blanca Talavera
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Enrique Martínez-Pías
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Javier Trigo-López
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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Patel J, Desai D, Desai S. Nummular Headache responding to Oxcarbazepine: A Rare Case. Ann Indian Acad Neurol 2021; 23:722-724. [PMID: 33623286 PMCID: PMC7887469 DOI: 10.4103/aian.aian_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jalpan Patel
- Intern Doctor, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Devangi Desai
- Department of Medicine, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Soaham Desai
- Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
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13
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Sharawat I, Panda P, Moirangthem V. Nummular headache: A rare headache type in a child responding to carbamazepine and gabapentin. Ann Indian Acad Neurol 2021; 24:943-944. [PMID: 35359546 PMCID: PMC8965928 DOI: 10.4103/aian.aian_722_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022] Open
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Thomas DC, Heir GM, Patil AG, Soni PK. Nummular Headache - a Case Report of a Rare Entity. Curr Pain Headache Rep 2020; 24:71. [PMID: 33047184 DOI: 10.1007/s11916-020-00901-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to shed light on systematic work-up of a diagnostic challenge such as nummular headache (NH), and to summarize the relevant literature on NH. RECENT FINDINGS The specific nature of the shape of the pain site is usually characteristic of NH. Multiple modalities of investigation including succinct imaging are necessary to successfully rule out other similar conditions. A 26-year-old female patient of Asian-Indian origin presented to the clinic with the chief complaint of chronic persistent left parietal headache for more than 10 years, which has been worsening over the past few days with no specific identifiable trigger. The diagnosis of nummular headache is challenging and confusing due to the rare occurrence and inadequate references in the literature. Appropriate imaging was done, which revealed no pathology that could explain the headache presentation. These findings are consistent with our diagnosis of nummular headache, and helped in the successful management of the case.
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Affiliation(s)
- Davis C Thomas
- Center for TMD and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA.
| | - Gary M Heir
- Center for TMD and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Amey G Patil
- Department of Restorative Dentistry and Department of Diagnostic Sciences, Center for TMD and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Prutha K Soni
- Center for TMD and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA
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Santos-Lasaosa S, Cuadrado M, Gago-Veiga A, Guerrero-Peral A, Irimia P, Láinez J, Leira R, Pascual J, Porta-Etessam J, Sánchez del Río M, Viguera Romero J, Pozo-Rosich P. Evidencia y experiencia del uso de onabotulinumtoxinA en neuralgia del trigémino y cefaleas primarias distintas de la migraña crónica. Neurologia 2020; 35:568-578. [DOI: 10.1016/j.nrl.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022] Open
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Evidence of and experience with the use of onabotulinumtoxinA in trigeminal neuralgia and primary headaches other than chronic migraine. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Souza WPDO, Sousa‐Santos PM, Silva‐Néto RP. A Historical Review of Headaches: Who First Described Them and When did This Occur? Headache 2020; 60:1535-1541. [DOI: 10.1111/head.13906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
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Baldelli I, Lucia Mangialardi M, Salgarello M, Raposio E. Nummular Headache and Its Surgical Treatment. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2989. [PMID: 32802677 PMCID: PMC7413807 DOI: 10.1097/gox.0000000000002989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/26/2020] [Indexed: 01/03/2023]
Abstract
Nummular headache (NH) is an uncommon primary headache characterized by pain limited to a precise small area of the scalp. There is no global consensus on its pathogenesis, but its extracranial origin is the most accepted theory. Moreover, peripheral mechanism is supported by the overlapping symptomatology of secondary forms of NH and is well described in the literature. However, a standard effective treatment is still lacking. METHODS A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to evaluate surgical strategies for NH. Inclusion criteria were English language, diagnosis of primary NH according to International Classification of Headache Disorders, 3rd Edition, or of secondary NH, and follow-up at a minimum of 3 months. The treatment had to consist of peripheral surgery. RESULTS One hundred eighty-seven records were identified after duplicates were removed, 15 full-text articles were assessed for eligibility, and 4 records were selected for inclusion. A total of 53 patients were included in this review, 50 of whom were diagnosed with primary NH. The general positive response after surgery (>50% reduction in occipital migraine headaches) was about 70.0% for primary NH, while secondary NH always showed complete pain relief. However, many variations in patient selection and type of surgery were described. CONCLUSIONS Neurovascular relationship in the extracranial tissues seems to be involved in the onset of NH. However, only limited data from meager literature and from few patients are currently available. Shared multicentric research protocols are badly required.
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Affiliation(s)
- Ilaria Baldelli
- From the Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate–DISC, Università degli Studi di Genova, Genova, Italy
| | - Maria Lucia Mangialardi
- Istituto di Clinica Chirurgica, Dipartimento Scienze della Salute della Donna e del Bambino, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marzia Salgarello
- Istituto di Clinica Chirurgica, Dipartimento Scienze della Salute della Donna e del Bambino, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Edoardo Raposio
- From the Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate–DISC, Università degli Studi di Genova, Genova, Italy
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Gago-Veiga A, García-Azorín D, Mas-Sala N, Ordás C, Ruiz-Piñero M, Torres-Ferrús M, Santos-Lasaosa S, Viguera Romero J, Pozo-Rosich P. How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the emergency department or primary care: Recommendations of the Spanish Society of Neurology's Headache Study Group. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Patel UK, Saleem S, Anwar A, Malik P, Chauhan B, Kapoor A, Arumaithurai K, Kavi T. Characteristics and treatment effectiveness of the nummular headache: a systematic review and analysis of 110 cases. BMJ Neurol Open 2020; 2:e000049. [PMID: 33681785 PMCID: PMC7871727 DOI: 10.1136/bmjno-2020-000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/17/2020] [Accepted: 03/01/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/OBJECTIVE Nummular headache (NH) is a primary headache disorder characterised by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp. As there are limited data in the literature on NH, we conducted this review to evaluate demographic characteristics and factors associated with complete resolution of the headache, and effectiveness of treatment options. METHODS We performed a systematic review of cases reported through PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and 'nummular headache', 'coin-shaped headache' and 'coin-shaped cephalalgia' keywords. Analysis was performed by using χ2 test and Wilcoxon rank-sum test. For individual interventions, the response rate (RR%) of the treatment was calculated. RESULTS We analysed a total of 110 NH cases, with median age 47 years and age of pain onset 42 years. Median duration to make correct diagnosis was 18 months after first attack. The median intensity of each attack was 5/10 on verbal rating scale over 4 cm diameter with duration of attack <30 min. Patients with NH had median three attacks per day with frequency of 9.5 days per month. 40 (57.97%) patients had complete resolution of the headache after treatment. Patients with complete resolution were younger, more likely to be female, and were more likely to have diagnosis within year. Patients with complete resolution more likely to have received treatment with onabotulinum toxin A (botulinum toxin type A (BoNT-A)), and gabapentin compared with patients without complete resolution. Most effective interventions were gabapentin (n=34; RR=67.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (n=32; RR=65.6%), BoNT-A (n=12; RR=100%) and tricyclic antidepressant (n=9; RR=44.4%). CONCLUSION Younger patients, female sex and early diagnosis were associated with complete resolution. NSAIDs, gabapentin and BoNT-A were most commonly used medications, with significant RRs.
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Affiliation(s)
- Urvish K Patel
- Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sidra Saleem
- Department of Neurology, University of Toledo, Toledo, Ohio, USA
| | - Arsalan Anwar
- Department of Neurology, UH Cleveland Medical Center, Cleveland, Ohio, USA
| | - Preeti Malik
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bindi Chauhan
- Department of Public Health, Long Island University, Brooklyn, New York, USA
| | - Ashish Kapoor
- Department of Neurology, Bayonne Medical Center, Bayonne, New Jersey, USA
| | | | - Tapan Kavi
- Department of Neurology, Rowan University Cooper Medical School, Camden, New Jersey, USA
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Pellesi L, Cevoli S, Favoni V, Lupi C, Mampreso E, Negro A, Russo A, Benemei S, Guerzoni S. Nummular headache: a gender-oriented perspective on a case series from the RegistRare Network. Neurol Sci 2019; 41:583-589. [DOI: 10.1007/s10072-019-04129-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/26/2019] [Indexed: 12/16/2022]
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García-Azorín D, Trigo-López J, Sierra Á, Blanco-García L, Martínez-Pías E, Martínez B, Talavera B, Guerrero ÁL. Observational, open-label, non-randomized study on the efficacy of onabotulinumtoxinA in the treatment of nummular headache: The pre-numabot study. Cephalalgia 2019; 39:1818-1826. [DOI: 10.1177/0333102419863023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Nummular headache is a primary headache characterised by superficial, coin-shaped pain. Superficial sensory fibre dysfunction might be involved in its pathophysiology. Considering the mechanism of action of onabotulinumtoxinA, it could be a reasonable option in treatment of nummular headache. The aim of the study was to evaluate the efficacy and tolerability of onabotulinumtoxinA in a series of nummular headache patients. Patients and methods This was an observational, prospective, non-randomized and open-label study. Nummular headache patients with at least 10 headache days in three preceding months were included. They were administered 25 units of onabotulinumtoxinA. The primary endpoint was the decrease of headache days per month, evaluated between weeks 20 to 24, compared with baseline. The secondary endpoints included reduction of intense headache days and acute treatment days evaluated between weeks 20–24 and weeks 8–12, compared with baseline. The 30%, 50% and 75% responder rates were determined, and tolerability described. Results We included 53 patients, 67.9% females, with a median age of 54 years. Preventive treatment had been used previously in 60.4% of patients. The median diameter of the nummular headache was 5 cm. At baseline, the number of headache days per month was 24.5 (7.3); the number of intense headache days was 12.5 (10.1), and the number of acute treatment days was 12.8 (7.8). After onabotulinumtoxinA, the mean number of headache days per month decreased to 6.9 (9.3) between weeks 20 and 24 ( p < 0.001). Secondary endpoints concerning intense headache days per month and acute treatment days per month were also statistically significant ( p < 0.001). The 50% responder rate, evaluated between weeks 20 and 24, was 77.4% and the 75% responder rate was 52.8%. Concerning tolerability, 26 patients (49.1%) experienced an adverse event (AE), the commonest being injection-site pain in 12 cases (22.6%). There were no moderate or severe AEs. Conclusion It was found that after injecting onabotulinumtoxinA, the number of headache days per month was reduced in nummular headache patients. The number of intense headache days per month and acute treatment days were also lowered. No serious adverse events occurred during treatment.
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Affiliation(s)
- David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Javier Trigo-López
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Enrique Martínez-Pías
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Blanca Martínez
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Blanca Talavera
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángel L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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Trigo J, García-Azorín D, Martinez Pias E, Sierra Á, Chavarría A, Guerrero AL. Clinical characteristics of nummular headache and differentiation between spontaneous and posttraumatic variant: an observational study. J Headache Pain 2019; 20:34. [PMID: 30961529 PMCID: PMC6734533 DOI: 10.1186/s10194-019-0981-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/14/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Head trauma has been described as a precipitating event in Nummular Headache (NH). We aimed to describe the largest NH published series and compare characteristics between idiopathic and post-traumatic cases. METHODS Patients attended in a Headache Unit in a tertiary hospital (January 2008-January 2018). NH diagnosed according to International Classification of Headache Disorders (ICHD) criteria. We prospectively considered clinical and epidemiological data, comparing idiopathic cases with those precipitated by a cranial trauma. RESULTS We included 225 patients (145 women, 80 men) with NH. Median latency between onset and diagnosis was 10 months (IQR: 5-24). Symptomatic treatment was used in 190 patients (84.4%) among which 142 (74.7%) experienced response to it. Preventive treatment was necessary in 127 patients (51.4%), among which 95 (74.8%) achieved response. 29 patients (23 women, 6 men) described a head trauma related to beginning of pain. When comparing groups with or without previous trauma, age of onset was higher among post-traumatic patients (59.9 ± 17.4 vs 48.1 ± 18 years, p: 0.001). Allodynia upon palpation was encountered more frequently in trauma triggered painful areas (53.3% vs. 32.7%, p: 0.02). No other clinical characteristics differences were observed. CONCLUSION Cranial trauma is not a rare trigger of NH. Patients with post-traumatic forms are older and the presence of allodynia is more frequent.
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Affiliation(s)
- Javier Trigo
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Enrique Martinez Pias
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Alba Chavarría
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Angel Luis Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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García-Azorín D, Dotor García-Soto J, Martínez-Pías E, Guerrero-Peral AL. Epicrania Fugax as the presenting symptom of a cerebellar abscess. Cephalalgia 2019; 39:1200-1203. [DOI: 10.1177/0333102419839793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Epicrania fugax is included in the appendix of the International Classification of Headache Disorders and is characterized as recurrent brief attacks of linear or zigzag pain moving across the cranial surface, commencing and terminating in the distribution of different nerves. We present a new case of epicrania fugax in which the headache was the presenting symptom of a cerebellar abscess. Case report We present a 58-year-old woman with prior history of Chiari I malformation who underwent suboccipital craniectomy. Two weeks after surgery, she experienced paroxysmal pain episodes of 1–3 seconds, with constant linear trajectory from the right occipital surface to the right orbital region, remaining pain free between episodes. Cranial tomography showed a hypodense intraaxial lesion in the right cerebellar hemisphere. Magnetic Resonance Imaging exhibited intralesional bleeding and peripheral enhancement after gadolinium administration. Post-surgical cerebellar abscess was diagnosed and antibiotic therapy was started; the patient underwent urgent surgical drainage. Pain disappeared after the surgery and the patient remains pain free with 12 months of follow-up. Conclusion Posterior fossa abnormalities have been described as a possible cause of secondary epicrania fugax. The presence of red flags should encourage conducting of paraclinical tests to rule out a symptomatic form.
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Affiliation(s)
| | | | | | - Angel L Guerrero-Peral
- Headache Unit, University Hospital of Valladolid, Valladolid, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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Jiang L, Li M, Liu Q, Liu C, Zhou J. Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review. Headache 2019; 59:593-602. [PMID: 30869172 DOI: 10.1111/head.13503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Li Jiang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Maolin Li
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Qing Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Chaoyang Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Jiying Zhou
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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Liu Y, Wei T. First three cases of scalp temperature change in symptomatic areas affected by nummular headache: a case report. BMC Neurol 2018; 18:223. [PMID: 30593265 PMCID: PMC6309064 DOI: 10.1186/s12883-018-1231-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/19/2018] [Indexed: 01/11/2023] Open
Abstract
Background Nummular headache is a distinct headache disorder characterized by a rounded or elliptical symptomatic area that is typically 2 to 6 cm in diameter and does not change in shape or size with time. Although the pathomechanism is still not clear, nummular headache is thought to be a primary headache disorder. To date, more than 250 cases have been reported; the symptoms of this disease vary, but no cases with scalp temperature changes in the symptomatic areas have been reported yet. In this study, we present three patients with a new manifestation of nummular headache, in which the symptomatic areas of the scalp were colder or warmer than normal areas; we believe that our work might be helpful for medical practitioners and researchers. Case presentation The temperature differences between the symptomatic areas and the normal areas were tested in three patients with nummular headache accompanied by changes in scalp temperature. Three patients’ symptomatic areas were either colder or warmer than the normal areas. In every case, we took measurements from the painful site and from the opposite side of the head. The margin of error was 0.01 °C, and the difference was statistically significant (P < 0.01). Conclusion We firmly believe that our study will provide an enriched understanding of the variation in clinical manifestations of nummular headache. Our observations might also have clinical implications regarding the pathomechanism of this disease, which remains largely unclear at present.
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Affiliation(s)
- Yonghui Liu
- Department of Encephalopathy, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530023, China
| | - Tianlu Wei
- Department of Encephalopathy, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530023, China.
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Abstract
Nummular headache (NH) is an unusual disorder attributed to a dysfunction of the epicranial nerves. We report a new series of cases, highlighting some clinical features, the association with other headaches, and the therapeutic response. Data of patients with NH, fulfilling ICHD-3 criteria, observed in a Headache Outpatient clinic during 5 years, were retrieved from records. Response to onabotulinumtoxinA was recorded prospectively and evaluated with a Headache Impact Test (HIT). Twenty-four patients, aged 53.8 (±14.6) years at diagnosis, 13 women, had definitive ( N = 21) or probable ( N = 3) NH for an average of 2.4 years. Headache was consistently localized, more frequently extratrigeminal ( N = 15) and parietal, and confined to the scalp. Pain was unremitting since onset in 58.3% of mild-to-moderate severity often with superimposed paroxysms (66.7%) and local allodynia (70.8%). In five cases, there was a possible precipitant. Thirteen patients reported other headaches, preceding NH by 8.2 years. In eight persistent cases, there was a significant improvement on HIT, after onabotulinumtoxinA. Despite its persistence, NH may go unrecognized for years. It often follows other headache types and has some tropism for hair-covered regions of the scalp. OnabotulinumtoxinA seems effective in persistent cases.
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Affiliation(s)
- Isabel Pavão Martins
- Headache Outpatient Clinic, Department of Neurology, Hospital de Santa Maria, CHLN Lisbon, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Luis Abreu
- Headache Outpatient Clinic, Department of Neurology, Hospital de Santa Maria, CHLN Lisbon, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Cuadrado ML, López-Ruiz P, Guerrero ÁL. Nummular headache: an update and future prospects. Expert Rev Neurother 2017; 18:9-19. [DOI: 10.1080/14737175.2018.1401925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- María Luz Cuadrado
- Department of Neurology, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Pedro López-Ruiz
- Department of Neurology, Hospital Universitario Quirón Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Ángel L Guerrero
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, School of Medicine, Universidad de Valladolid (UVA), Valladolid, Spain
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How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the Emergency department or Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia 2017; 35:176-184. [PMID: 28870393 DOI: 10.1016/j.nrl.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected. In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia. DEVELOPMENT Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. CONCLUSIONS We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment.
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Barón-Sánchez J, Gutiérrez-Viedma Á, Ruiz-Piñero M, Pérez-Pérez A, Guerrero ÁL, Cuadrado ML. Epicrania fugax combining forward and backward paroxysms in the same patient: the first four cases. J Pain Res 2017; 10:1453-1456. [PMID: 28721087 PMCID: PMC5499947 DOI: 10.2147/jpr.s135810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background The first description of epicrania fugax (EF) reported brief painful paroxysms that start in posterior regions of the scalp and move forward to reach the ipsilateral forehead, eye, or nose. A backward variation, wherein pain stems from frontal areas and radiates to the posterior scalp, has also been acknowledged. We report four patients with features reminiscent of EF and the coexistence of forward and backward pain paroxysms. Methods We considered all patients attending the headache outpatient office at two tertiary hospitals from March 2008 to March 2016. We enrolled four patients with paroxysms fulfilling criteria for EF and a combination of forward and backward radiations. Results In all cases, pain paroxysms moved both in forward and backward directions with either a zigzag (n=2) or linear (n=2) trajectory. Three patients presented two stemming points, in the occipital scalp and forehead (n=2) or in the parietal area and eye (n=1), whereas the fourth patient only had a stemming point located in the parietal region. Pain quality was mainly stabbing, and its intensity was moderate (n=1) or severe (n=3). The duration of the paroxysms was highly variable (3–30 seconds), and two patients reported autonomic symptoms. Conclusion The clinical picture presented by our patients does not fit with other types of known headache or neuralgia syndromes; we propose it corresponds to a bidirectional variant of EF.
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Affiliation(s)
- Johanna Barón-Sánchez
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Marina Ruiz-Piñero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Ángel Luis Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Department of Medicine, School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Silva Rosas C, Angus-Leppan H, Lemp MB, Rozas JP, Quijada AH. Langerhans cell histiocytosis (eosinophilic granuloma) of the skull mimicking nummular headache. Report of two cases. Cephalalgia 2017; 38:794-797. [DOI: 10.1177/0333102417708772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Nummular headache is a rare, recently described topographic headache defined by the circumscribed coin-shaped area of pain. It is classified as a primary headache. There is debate about whether it is due to a peripheral or central disturbance, and its relationship to migraine. Case reports We report two patients with presumed nummular headache secondary to Langerhans cell histiocytosis, both with resolution of their headaches after surgical resection. Conclusion Imaging in patients with clinical features of nummular headache is recommended, as this and other cases highlight that it may be symptomatic. There are no distinguishing clinical features to separate nummular headache from secondary mimics, and treatment of the underlying cause may be curative.
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Affiliation(s)
- Carlos Silva Rosas
- Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Santiago de Chile, Chile
| | - Heather Angus-Leppan
- Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Melchor Bruno Lemp
- Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Santiago de Chile, Chile
| | - Juan Pablo Rozas
- Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Santiago de Chile, Chile
| | - Alonso Humberto Quijada
- Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Santiago de Chile, Chile
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Abstract
Epicrania fugax (EF) is a primary headache of recent description. EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, commencing and terminating in the territories of different nerves. The pain of forward EF originates in a particular area of the occipital, parietal or temporal regions and moves anteriorly, whereas the pain of backward EF originates in the frontal area, the eye or the nose and moves posteriorly. Some patients have ocular or nasal autonomic accompaniments, and some have triggers. Between attacks, many patients have continuous or intermittent pain and/or tenderness at the stemming area. Pain frequency is extremely variable and some patients have spontaneous remissions. Preventive therapy is required when the paroxysms are frequent and non-remitting. Neuromodulators, indomethacin, amitryptiline, nerve anesthetic blockades, and trochlear steroid injections have been used in different cases, with partial or complete response.
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Rammohan K, Mundayadan SM, Mathew R. Nummular headache: Clinico-epidemiological features in South Indian population. J Neurosci Rural Pract 2016; 7:532-536. [PMID: 27695232 PMCID: PMC5006464 DOI: 10.4103/0976-3147.186984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
CONTEXT Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2-6 cm in diameter. AIMS The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. SETTINGS AND DESIGN A prospective, observational study conducted in a tertiary care center. MATERIALS AND METHODS Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient. RESULTS A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36-60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia. CONCLUSION Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain.
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Affiliation(s)
- K Rammohan
- Department of Neurology, TD Medical College Hospital, Alappuzha, Kerala, India
| | | | - Robert Mathew
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
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Camacho-Velasquez JL. Nummular Headache Associated With Linear Scleroderma. Headache 2016; 56:1492-1493. [PMID: 27477768 DOI: 10.1111/head.12894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
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Chirchiglia D, Della Torre A, Signorelli F, Volpentesta G, Guzzi G, Stroscio CA, Deodato F, Gabriele D, Lavano A. Administration of palmitoylethanolamide in combination with topiramate in the preventive treatment of nummular headache. Int Med Case Rep J 2016; 9:193-5. [PMID: 27486344 PMCID: PMC4957685 DOI: 10.2147/imcrj.s106323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Nummular headache has been recently described as a primary disorder characterized by head pain exclusively felt in a small rounded area typically 2–6 cm in diameter, not attributed to another disorder. Both size and shape of the painful area remain constant since the onset of symptoms. A 57-year-old woman presented with a history of focal episodic pain in a circumscribed area on the right parietal region. The administration of standard oral doses of palmitoylethanolamide and topiramate in combination showed an improvement in pain symptoms and on pain measuring scales.
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Affiliation(s)
| | - Attilio Della Torre
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giorgio Volpentesta
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giusy Guzzi
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | | | - Federica Deodato
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Donatella Gabriele
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Angelo Lavano
- Department of Neurosurgery, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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40
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Affiliation(s)
- M Trucco
- Headache Centre, Department of Neurology, Azienda Ospedaliera S. Corona, Pietra Ligure (SV) and Headache Centre, Department of Neurosciences, Padua University, Padua, Italy.
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Abstract
Nummular headache is proposed as a distinct type of headache in the Appendix of the second edition of the International Classification of Headache Disorders (ICHD-II). It is a chronic condition, with the following characteristics: pain is felt on a small circumscribed cranial area; pain is of mild to moderate intensity; there is no evidence of a structural abnormality. Herein, three cases fulfilling the ICHDII proposed criteria (code A13.7.1) for nummular headache are reported.
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Affiliation(s)
- F Dach
- Department of Neurology, University of Sao Paulo, School of Medicine at Ribeirao Preto, Sao Paulo, Brazil.
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Fernández-de-las-Peñas C, Cuadrado ML, Barriga FJ, Pareja JA. Pericranial Tenderness is Not Related to Nummular Headache. Cephalalgia 2016; 27:182-6. [PMID: 17257241 DOI: 10.1111/j.1468-2982.2007.01253.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to investigate whether nummular headache (NH) patients show increased pericranial tenderness in relation to healthy subjects, and to compare pericranial tenderness between both NH and chronic tension-type headache (CTTH) patients. Three tenderness (total, cephalic and neck) scores were objectively and blinded assessed in 10 NH patients, 10 CTTH subjects and 10 healthy matched controls. No significant differences were found in any tenderness score between the symptomatic and non-symptomatic sides in NH, or between right and left sides in either CTTH or control groups. All tenderness scores were significantly greater in CTTH patients compared with both NH patients and controls ( P < 0.001), but not significantly different between NH patients and controls. Therefore, NH patients had lower tenderness than patients with CTTH and did not show increased tenderness when compared with healthy subjects. In addition, tenderness in NH patients was quite symmetrical between both the symptomatic and the non-symptomatic sides. The absence of increased pericranial tenderness could be clinically useful in distinguishing NH from CTTH. Current findings expand the evidence supporting the notion that NH is a non-generalized and rather limited disorder, marking the presence of a well-delimited painful zone.
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Affiliation(s)
- C Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain.
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Nelson S, Taylor LP. Headaches in brain tumor patients: primary or secondary? Headache 2016; 54:776-85. [PMID: 24697234 DOI: 10.1111/head.12326] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Headaches occur commonly in all patients, including those who have brain tumors. It has been argued that there is a classic "brain tumor headache type" - defined by the International Headache Society as one that is localized, progressive, worse in the morning, aggravated by coughing or bending forward, develops in temporal and often spatial relation to the neoplasm, and resolves within 7 days of surgical removal or treatment with corticosteroids. METHODS Using the search terms "headache and brain tumors," "intracranial neoplasms and headache," and "facial pain and brain tumors," we reviewed the literature from the past 20 years on brain tumor-associated headache and reflected upon the International Classification of Headache Disorders-3 (ICHD-3). In a separate, complementary paper, the proposed mechanisms of brain tumor headache are reviewed. RESULTS We discuss multiple clinical presentations of brain tumor headaches, present the ICHD-3 diagnostic criteria for each type of headache, and then apply our findings to the ICHD-3. Our primary and major finding was that brain tumor headaches can present similarly to primary headaches in those with a predisposition to headaches, suggesting that following ICHD-3 criteria could cause a clinician to overlook a headache caused by a brain tumor. We further find that some types of headaches are not explicitly discussed in the ICHD-3 and also propose that the International Headache Society formally define SMART (Stroke-like Migraine Attacks after Radiation Therapy) syndrome given the increasing amount of literature on this disorder. CONCLUSION Our literature review revealed that brain tumor headache uncommonly presents with classic brain tumor headache characteristics and often satisfies criteria for a primary headache category such as migraine or tension-type. Thus, clinicians may miss headaches due to brain tumors in following ICHD-3 criteria, and the distinction between primary and secondary headache disorders may not be so clear-cut.
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Affiliation(s)
- Sarah Nelson
- Departments of Neurology, Tufts Medical Center, Boston, MA, USA
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Wang L, Pan JF, Lu YY, Hu LH, Lu YN, Pan QQ, Wang Y. A recurrent headache circumscribed in a coronal line-shaped area around the head: a coronal linear headache. SPRINGERPLUS 2016; 5:315. [PMID: 27066346 PMCID: PMC4786508 DOI: 10.1186/s40064-016-1786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/12/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Linear headache (LH) has recently been described as a paroxysmal or continuous head pain restricted in a linear trajectory of 5-10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. The sagittal line-shaped pain area of LH is close and parallel to a sagittal venous sinus, the superior sagittal sinus (SSS). For some patients, the LH had some features resembling the pattern of migraine without aura. CASE DESCRIPTION A 45 year-old woman complained with a distinct headache for more than half years. The pain trajectory of the headache is confined to a coronal line-shaped area of 5-10 mm in width linking the two points in the bilateral temporal regions with the occipital protuberance. This coronal line-shaped pain area is close and parallel to a coronal cambered venous sinus complex, the combination of the confluences of sinus and the bilateral cavernous sinus (CS), superior petrosal sinus (SPS) linking the CS with transverse sinus (TS) and TS into which the SPS feeds. The patient had a past history of migraine without aura for 10 years and her son had a benign paroxysmal vertigo (BPV) for 12 years. Both of her coronal line-shaped headache and her son's vertigo had well response to sodium valproate. DISCUSSION AND EVALUATION Its clinical characteristics were distinctly different from those of other two headache entities defined with topographical criteria, nummular headache and epicrania fugax, and different from other existing headache entities except for migraine without aura. CONCLUSION The distinct coronal line-shaped headache is suggestive of a variant of LH, a coronal LH, and probably belongs to a subtype of migraine without aura as proposed for LH. This coronal LH reinforces the proposal of LH as a new headache syndrome or a subtype of a previously known headache syndrome, probably of migraine.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Jie-Feng Pan
- Department of Cardiology, The Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
| | - Yun-Yun Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Liang-Hui Hu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Ya-Nan Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Qing-Qing Pan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China ; Department of Neurology, The Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
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Lu YN, Pan QQ, Pan JF, Wang L, Lu YY, Hu LH, Wang Y. Linear headache: clinical characteristics of eight new cases. SPRINGERPLUS 2016; 5:347. [PMID: 27057481 PMCID: PMC4799045 DOI: 10.1186/s40064-016-1991-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/10/2016] [Indexed: 01/03/2023]
Abstract
Background Linear headache (LH) has recently been described as a paroxysmal or continuous fixed head pain restricted in a linear trajectory of 5–10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. For some patients, this headache had some features resembling migraine without aura. Methods We made a prospective search of patients presenting with a clinical picture comprised under the heading of LH and we have accessed eight new cases. A detailed clinical feature of the headache was obtained in all cases to differentiate with cranial neuralgia, paroxysmal hemicrania, cervicogenic headache, nummular headache and migraine. Results The eight LH patients complained of a recurrent moderate to severe, distending, pulsating, or pressure-like pain within a strictly unilateral line-shaped area. The headache duration would be ranged from 1 h to 2 days or persistent for 1–6 months with recurrent worsening of headaches. For some patients, this headache had couple of features similar to that of migraine pattern, such as accompaniments of nausea, vomiting, and phonophobia, diziness, triggering factors of noise, bright night, resting after physical activity, fatigue, menstruation, and response to anti-migraine therapy. Conclusions This description reinforces the proposal of LH as a new headache syndrome or a new variant of a previously known headache syndrome, probably of migraine.
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Affiliation(s)
- Ya-Nan Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Qing-Qing Pan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Jie-Feng Pan
- Department of Cardiology, the Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
| | - Lei Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Yun-Yun Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Liang-Hui Hu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China.,Department of Neurology, the Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
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Rodríguez C, Herrero-Velázquez S, Ruiz M, Barón J, Carreres A, Rodríguez-Valencia E, Guerrero AL, Madeleine P, Cuadrado ML, Fernández-de-Las-Peñas C. Pressure pain sensitivity map of multifocal nummular headache: a case report. J Headache Pain 2015; 16:523. [PMID: 25929432 PMCID: PMC4417469 DOI: 10.1186/s10194-015-0523-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/23/2015] [Indexed: 01/03/2023] Open
Abstract
Background Nummular headache (NH) is most commonly a localized unifocal headache; however, some patients infrequently exhibit multifocal symptomatic painful head areas retaining all features of NH. We present the pressure pain sensitivity map of an adolescent with multifocal NH. Case presentation We describe a case of a 14 year-old-girl with a 3-year history of continuous pain in four rounded areas, all of them with the same size and shape. Pressure pain thresholds (PPT) were assessed on 21 points over the scalp and over the symptomatic areas. A pressure pain sensitivity map of the head was constructed. The neurological exam was unremarkable, with neither sensory symptoms nor trophic changes within the painful areas. As previously shown, symptomatic points exhibited lower PPTs compared to the surrounding areas. The map reflected 4 restricted areas of mechanical hyperalgesia confined just to the painful areas. Treatment with gabapentin achieved complete remission. Conclusion This is the first pain sensitivity map of a patient with multifocal NH. Our results support peripheral mechanisms are maintained in multifocal NH.
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Affiliation(s)
- Cristina Rodríguez
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain,
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Abstract
Nummular headache is a type of headache that can be identified by continuous or intermittent pain occuring in a well-circumscribed area. The symptoms of nummular headache can overlap with those of migraine headache, and a failure to reach an accurate diagnosis can affect the choice of treatment. The authors report a case involving a 21-year-old woman with headache symptoms that appeared to represent nummular headache, for whom treatment with the typical first-line agent was unsuccessful. The authors subsequently generated a pressure algometry map of the painful area, leading to clarification of the diagnosis. A peripheral mechanism has been proposed for nummular headache; however, there have been descriptions of atypical features resembling migraine. The authors describe a case in which algometry assessment facilitated the discrimination between atypical nummular headache and circumscribed migraine. A 21-year-old woman presented with a history of focal episodic pain in a circumscribed area on the left frontal region. The algometry study showed a unilateral and diffuse decrease of the pain pressure thresholds with frontal predominance, as has been proposed for migraine patients. This result led the authors to introduce a more specific preventive therapy with topiramate, with significant relief. In conclusion, cartographic investigation of pressure pain sensitivity is a simple tool that can help to differentiate between nummular headache and migraine. Further confirmatory investigations are needed.
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Kurian M, Solomon GD. Can temporal course of pain determine patient response to specific medication in nummular headache? Headache 2014; 54:1058-61. [PMID: 24666155 DOI: 10.1111/head.12331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Michelle Kurian
- Department of Internal Medicine, Wright State University, Dayton, OH, USA
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López-Mesonero L, Porta-Etessam J, Ordás CM, Muñiz-Castrillo S, Cuadrado ML. Nummular headache in a patient with craniosynostosis: one more evidence for a peripheral mechanism. PAIN MEDICINE 2013; 15:714-6. [PMID: 24341452 DOI: 10.1111/pme.12324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Luis López-Mesonero
- Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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