Abstract:
Nummular headache is an uncommon chronic headache syndrome characterized by constant localized pain with superimposed paroxysms of stabbing jabs and jolts of mild to moderate intensity that occur in a coin-shaped localized area of the scalp. Most commonly located in the parietal region, the pain of nummular headache is unilateral and localized to a single area. It rarely if ever switches sides. The scalp overlying the area may be tender to touch and stimulation of the area; for example, the brushing of hair may exacerbate the pain. Nummular headache occurs slightly more commonly in women and is generally not seen before the fourth decade of life, but rare reports of children suffering from nummular headache sporadically appear in the literature. Nummular headache has been associated with coexistant migraine headache and occipital neuralgia. A high prevalence of autoimmune indicies and disorders have also been identified in patients suffering from nummular headache.
Keywords
Autoimmune diseases Autoimmune diseases, coin-shaped headache coin-shaped headache, headache headache, magnetic resonance imaging magnetic resonance imaging, migraine headache migraine headache, nummular headache nummular headache, occipital neuralgia occipital neuralgia
ICD-10 CODE R51
The Clinical Syndrome
Nummular headache is an uncommon chronic headache syndrome characterized by constant localized pain with superimposed paroxysms of stabbing jabs and jolts of mild to moderate intensity that occur in a coin-shaped localized area of the scalp. Most commonly located in the parietal region, the pain of nummular headache is unilateral and localized to a single area. It rarely if ever switches sides. The scalp overlying the area may be tender to touch and stimulation of the area; for example, the brushing of hair may exacerbate the pain. Nummular headache occurs slightly more commonly in women and is generally not seen before the fourth decade of life, but rare reports of children suffering from nummular headache sporadically appear in the literature. Nummular headache has been associated with coexistent migraine headache and occipital neuralgia. A high prevalence of autoimmune indices and disorders have also been identified in patients suffering from nummular headache. Nummular headache is also known as coin-shaped headache.
Signs and Symptoms
A patient with nummular headache complains of a unifocal region of pain and sensitivity most commonly occurring in the vertex of the parietal region ( Fig. 11.1 ). The pain is almost always unilateral and does not switch sides, although rare reports exist of bilateral nummular headache. Some patients describe the pain of nummular headache as a constant dull ache or sensitivity in the affected area with superimposed paroxysms of lancinating pain. The pain is chronic, although spontaneous remissions have been rarely reported. Some patients with nummular headache exhibit anxiety and depression because the intensity of the associated pain leads many patients to believe they have a brain tumor.
Testing
Magnetic resonance imaging (MRI) of the brain provides the best information regarding the cranial vault and its contents. MRI is highly accurate and helps identify abnormalities that may put the patient at risk for neurological disasters secondary to intracranial and brainstem pathological conditions, including tumors and calvarial lesions ( Fig. 11.2 ). Magnetic resonance angiography (MRA) also may be useful in helping identify aneurysms, which may be responsible for the patient’s pain. In patients who cannot undergo MRI, such as patients with pacemakers, computed tomography (CT) is a reasonable second choice. Radionuclide bone scanning and plain radiography are indicated if fracture or bony abnormality, such as metastatic disease, is considered in the differential diagnosis.
