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Cuadrado ML. Epicranial headaches part 2: Nummular headache and epicrania fugax. Cephalalgia 2023; 43:3331024221146976. [PMID: 36855999 DOI: 10.1177/03331024221146976] [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: 03/02/2023]
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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Delussi M, Laporta A, Fraccalvieri I, de Tommaso M. Osmophobia in primary headache patients: associated symptoms and response to preventive treatments. J Headache Pain 2021; 22:109. [PMID: 34537019 PMCID: PMC8449918 DOI: 10.1186/s10194-021-01327-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
Background Osmophobia, is common among primary headaches, with prevalence of migraine. The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients. Methods This was an observational retrospective cohort study based on data collected in a tertiary headache center. We selected patients aged 18–65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up. Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10. Results The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia). Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia. Conclusions While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety. Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01327-2.
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Affiliation(s)
- Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Anna Laporta
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Ilaria Fraccalvieri
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy.
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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 2021; 2:e000049. [PMID: 33681785 PMCID: PMC7871727 DOI: 10.1136/bmjno-2020-000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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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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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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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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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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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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Iwanowski P, Kozubski W, Losy J. Nummular headache in a patient with ipsilateral occipital neuralgia—A case report. Neurol Neurochir Pol 2014; 48:141-3. [DOI: 10.1016/j.pjnns.2013.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/02/2013] [Indexed: 11/29/2022]
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Dai W, Yu S, Liang J, Zhang M. Nummular headache: Peripheral or central? One case with reappearance of nummular headache after focal scalp was removed, and literature review. Cephalalgia 2013; 33:390-7. [PMID: 23378434 DOI: 10.1177/0333102412474504] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Nummular headache, or coin-shaped cephalagia, is defined as a mild to moderate, pressure-like pain that is felt exclusively in a circumscribed area. More than 200 cases of nummular headache have been reported since it was defined in 2002, but the pathogenesis remains unclear. Methods A patient with nummular headache who had the symptomatic area of his scalp removed but suffered headache reappearance was reported. All published cases of nummular headache in the English literature were reviewed and analyzed for demographic and clinical features, image and laboratory findings, and response to treatment. Results The patient with nummular headache had the symptomatic area of the scalp removed but suffered reappearance of headache in another area that overlapped with the former one. The literature review showed that nummular headache was a chronic, mild to severe, pressure-like pain with a circular or elliptical shape of 1–10 cm in diameter. The parietal region was the most affected region. Exacerbations and sensory disturbances in the affected area were reported in 43% and 56% of cases, respectively. Observational data suggested botulinum toxin type A (BoNTA) and gabapentin may be beneficial. Discussion Our case and evidence from the literature review support the peripheral mechanism of nummular headache. Nummular headache might be a local pain disorder stemming from terminal branches of a sensory nerve and could induce peripheral sensitization in one or several primary sensory neurons.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Chinese PLA General Hospital, People’s Republic of China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, People’s Republic of China
| | - Jingyao Liang
- Department of Neurology, Chinese PLA General Hospital, People’s Republic of China
| | - Mingjie Zhang
- Department of Neurology, Chinese PLA General Hospital, People’s Republic of China
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Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianópolis Brazil
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Guerrero ÁL, Cortijo E, Herrero-Velázquez S, Mulero P, Miranda S, Peñas ML, Pedraza MI, Fernández R. Nummular headache with and without exacerbations: Comparative characteristics in a series of 72 patients*. Cephalalgia 2012; 32:649-53. [DOI: 10.1177/0333102412447537] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Apart from the characteristic chronic head pain in a coin-shaped circumscribed area, superimposed exacerbations have been described from early reports of nummular headache (NH). In a prospective series, we aim to compare the demographic and clinical characteristics between cases of exacerbations (ENH) and non-exacerbations (NENH) in NH. Methods and results: Seventy-two NH patients (44 female, 28 male) attending a headache outpatient office. As eight patients presented with bifocal NH we analysed 80 painful areas; 47 (58.8%) presented in situ exacerbations. Mean intensity of exacerbations was 7.5 ± 1.6 and they lasted 5.7 ± 11.6 minutes. Exacerbation quality was mostly stabbing. We found no differences between ENH and NEHN groups in age at onset, baseline pain intensity, size of painful area, allodynia or other sensory symptoms, or baseline pain quality. There were no differences between populations with respect to relief with symptomatic therapy, requirement of preventative therapy and its response to preventatives. Conclusion: In situ exacerbations superimposed on baseline pain are frequent in NH and might be included in diagnostic criteria. No statistically significant differences were found between ENH and NENH cases in demographic and nosological characteristics, or needing or response to therapy, but these sample sizes are small.
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Affiliation(s)
- Ángel L Guerrero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Elisa Cortijo
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Patricia Mulero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Sara Miranda
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - María Luz Peñas
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Rosa Fernández
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
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Cuadrado ML, Valle B, Fernández-de-las-Peñas C, Madeleine P, Barriga FJ, Arias JA, Arendt-Nielsen L, Pareja JA. Pressure pain sensitivity of the scalp in patients with nummular headache: a cartographic study. Cephalalgia 2011; 30:200-6. [PMID: 19489884 DOI: 10.1111/j.1468-2982.2009.01895.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nummular headache (NH) is characterized by focal pain fixed within a small round or elliptical area of the head surface. Sensory dysfunction is apparently restricted to the symptomatic area, but a thorough analysis of cranial pain sensitivity has not been performed. Pressure pain sensitivity maps were constructed for 21 patients with NH and 21 matched healthy controls. In each subject pressure pain thresholds (PPT) were measured on 21 points distributed over the scalp. In each patient PPT were also measured in the symptomatic area and at a non-symptomatic symmetrical point. In both groups an anterior to posterior gradient was found on each side, with no significant differences of PPT measurements between sides or groups. In patients with NH, only the symptomatic area showed a local decrease of PPT (significant in comparison with the non-symptomatic symmetrical point, P < 0.001). These findings further support that NH is a non-generalized disorder with a peripheral source.
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Affiliation(s)
- M L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos and Universidad Complutense, Madrid, Spain.
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Abstract
Introduction: Nummular headache is a rare primary headache disorder described by a focal circumscribed area of pain (2–6 cm in diameter). Literature on this disorder is sparse. Patients and methods: Here, we describe a case series of 16 patients (6 men, 10 women) seen at the Mayo Clinic. Results: Mean age of onset was 50 years (range, 19–79 years) and mean duration of headache was 7.9 years (range, 0.33–40 years). Location of headache varied and was found to be an average of 3.9 cm in diameter (range, 2–10 cm). Headache was episodic (<15 days/month) in four patients and chronic (>15 days/month) in 12 patients. Attention was paid to therapeutic interventions. Resolution was seen in 38% of patients. Migraine was present in the history of 56% of patients and medication overuse headache was found in 25%. Conclusions: Our series results support previous findings. In our population, no specific therapy was identified to be effective in more than one patient.
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Affiliation(s)
- Justin Moon
- Denver Neurological Clinic, Denver, Colorado, USA
| | - Kamran Ahmed
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ivan Garza
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Guerrero AL, Cuadrado ML, Porta-Etessam J, García-Ramos R, Gómez-Vicente L, Herrero S, Peñas ML, Fernández R. Epicrania fugax: ten new cases and therapeutic results. Headache 2010; 50:451-8. [PMID: 20100299 DOI: 10.1111/j.1526-4610.2009.01607.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We aimed to report 10 new cases of epicrania fugax (EF), showing their clinical features and therapeutic responses. BACKGROUND Epicrania fugax has been recently described as a paroxysmal head pain starting in a focal area located at a posterior cranial region and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. In some patients the pain is followed by ocular or nasal autonomic features. In the prior series, 1 patient got pain relief with anesthetic blockades, while another patient improved with carbamazepine. METHODS Since the first description of EF, we have assessed 10 patients with the same clinical picture (8 women and 2 men) at the Neurology outpatient offices of our 2 centers. RESULTS The mean age at onset was 48.5 years (SD: 19.8, range: 23-83). All the patients complained of strictly unilateral pain paroxysms starting at parietal (n = 5), occipital (n = 4), or parieto-occipital locations (n = 1), and immediately spreading forward through a linear pathway toward the ipsilateral forehead (n = 3) or the ipsilateral eye (n = 7), the complete sequence lasting 1-10 seconds. No trigger was identified in any of our patients, while 5 of them suffered mild pain in the stemming area between the paroxysms. Three patients had ipsilateral lacrimation, and 2 had conjunctival injection at the end of the attacks. The frequency ranged from 1 attack per week to multiple attacks per day. Neuroimaging and laboratory tests were consistently normal. Interictal pain was responsive to acetaminophen. In 3 cases a preventive was considered in order to avoid the paroxysms. Gabapentin led to significant improvement in 2 cases. The third patient did not obtain any benefit from gabapentin or amitriptyline, but improved slightly with lamotrigine. CONCLUSIONS This description reinforces the proposal of EF as a new headache variant or a new headache syndrome. Anesthetic blockades, carbamazepine, gabapentin, and lamotrigine have been apparently effective in individual patients. Further observations and therapeutic trials are needed.
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Affiliation(s)
- Angel L Guerrero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
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Ruscheweyh R, Buchheister A, Gregor N, Jung A, Evers S. Nummular headache: Six new cases and lancinating pain attacks as possible manifestation. Cephalalgia 2009; 30:249-53. [DOI: 10.1111/j.1468-2982.2009.01893.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- R Ruscheweyh
- Department of Neurology, University of Münster, Münster, Germany
| | - A Buchheister
- Department of Neurology, University of Münster, Münster, Germany
| | - N Gregor
- Department of Neurology, University of Münster, Münster, Germany
| | - A Jung
- Department of Neurology, University of Münster, Münster, Germany
| | - S Evers
- Department of Neurology, University of Münster, Münster, Germany
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Cuadrado ML, Valle B, Fernández C, Barriga FJ, Pareja JA. Bifocal Nummular Headache: The First Three Cases. Cephalalgia 2009; 29:583-6. [DOI: 10.1111/j.1468-2982.2008.01815.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nummular headache (NH) has been defined as a focal head pain that is exclusively felt in a small area of the head surface. Here we describe three patients who presented with focal head pain in two separate areas. This finding seems to be consistent with bifocal NH and further enlarges the clinical diversity of this headache disorder. The pathogenic mechanisms of NH may be active in multiple cranial areas in some particular patients.
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Affiliation(s)
- ML Cuadrado
- Department of Neurology, Hospital Clinico San Carlos, Universidad Complutense, Madrid
- Laboratory of Aesthesiology
| | - B Valle
- Laboratory of Aesthesiology
- Department of Physical Therapy, Hospital Universitario Fundación Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - C Fernández
- Laboratory of Aesthesiology
- Department of Physical Therapy, Hospital Universitario Fundación Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - FJ Barriga
- Laboratory of Aesthesiology
- Department of Neurology, Hospital Universitario Fundación Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - JA Pareja
- Laboratory of Aesthesiology
- Department of Neurology, Hospital Universitario Fundación Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Álvaro LC, Garcí JM, Areitio E. Nummular Headache: A Series with Symptomatic and Primary Cases. Cephalalgia 2009; 29:379-83. [DOI: 10.1111/j.1468-2982.2008.01722.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nummular headache (NH) is a primary headache adopting the form of local pain in a circumscribed area of < 7 cm in diameter in the tuber parietale, albeit it may also be located in other areas of the head. Although it is chronic, it is commonly associated with exacerbations and short periods of remission. Here we report four cases. Two of them could not be considered primary: in one the pain was related to an underlying, pointed and benign lesion disclosed only by magnetic resonance imaging (case 1); the second one had persistent NH days after trans-sphenoidal surgery for a pituitary adenoma, similar to a postcraniotomy headache (case 2). The two final patients suffered from typical forms of primary NH, one associated with migraine without aura, the other with chronic tension-type headache. The response to painrelated treatments and to preventive drugs was poor in the symptomatic as well as in the primary cases. The mechanisms are not clear, and peripheral (case 1) and also central pathways (case 2) could be involved. In the end, secondary forms of NH might coexist with classical primary NH. Particular attention should be paid to tiny skull lesions and to key events preceding the pain.
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Affiliation(s)
- LC Álvaro
- Department of Neurology, Basurto Hospital, Bilbao, Spain
| | - JM Garcí
- Department of Neurology, Basurto Hospital, Bilbao, Spain
| | - E Areitio
- Department of Neurosurgery, Basurto Hospital, Bilbao, Spain
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Mathew NT, Kailasam J, Meadors L. Botulinum toxin type A for the treatment of nummular headache: four case studies. Headache 2007; 48:442-7. [PMID: 18028377 DOI: 10.1111/j.1526-4610.2007.00960.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We assessed the efficacy and safety of botulinum toxin type A (BoNTA; BOTOX): Allergan, Inc., Irvine, CA, USA) in patients with nummular headache who did not respond to other treatments including nonsteroidal anti-inflammatory drugs (NSAIDs), local anesthetics, and/or gabapentin. BACKGROUND Nummular headache is characterized by circumscribed round or elliptical areas of fluctuating mild-to-moderate head pain in a chronic or remitting pattern. It is a relatively rare primary headache disorder that responds poorly to adequate treatment trials with local anesthetic, migraine, or neuropathic pain agents or NSAIDs. METHODS Four patients aged 35-58 years with intractable nummular headaches were given 25 units of BoNTA divided among 10 injection sites in and around the circumscribed affected areas of pain, paresthesia, and allodynia. All patients had 2 sets of injections approximately 14 weeks apart. RESULTS All patients met the International Headache Society criteria for nummular headache (International Classification of Headache Disorders, A13.7.1). Patients were female; mean age of onset was 42 years. Average disease duration prior to BoNTA treatment was 3.75 years. One patient reported concurrent episodic migraine and another reported concurrent tension-type headache. Patients reported round-shaped (n = 2; 6 and 3 cm in diameter), oval (n = 1; 4 x 2 cm), and elliptical (n = 1; 6 cm in length) areas of pain. Painful symptoms were reported in the right parietal convexity (n = 2) and the posterior frontal, unilaterally (n = 2). All patients experienced spontaneous or stimuli-triggered exacerbations and variable combinations of sensory disturbances, including allodynia, tenderness, and paresthesia. The temporal pattern was continuous in 3 patients and intermittent in one. Both the size and shape of the pain remained unchanged in all patients since the onset of nummular headache symptoms. Six to 10 days following BoNTA treatment, all patients experienced a reduction in nummular headache symptoms, which lasted approximately 14 weeks on average. Repeat injections gave the same degree of improvement. No treatment-related adverse events were reported. CONCLUSIONS BoNTA appears to be a well-tolerated effective treatment for intractable, persistent nummular headache in patients with an inadequate response to other treatments including NSAIDs, gabapentin, or local anesthetics.
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Affiliation(s)
- Ninan T Mathew
- Houston Headache Clinic - Neurology, Houston, TX 77004, USA
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25
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Abstract
Nummular headache is a rare primary headache disorder characterized by focal and well-circumscribed pain fixed within a round-, oval-, or elliptical-shaped region of the head. The pain is usually mild to moderate in intensity but may be severe. Nummular headache is most common in women in the fourth to fifth decade of life. The temporal pattern may be chronic and continuous since onset, chronic evolved from episodic, or episodic. These headaches typically are unilateral, side-locked, and fixed in location, commonly affecting the parietal region. Many patients experience superimposed exacerbations of pain, lasting from seconds to days. Sensory phenomena, such as paresthesias, allodynia, and dysesthesias, are frequently reported in the region of the pain. Treatment with gabapentin, tricyclic antidepressants, or botulinum toxin may be helpful.
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