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nummular headache; coin-shaped cephalgia
Epidemiology:
- rare
Pathology:
- likely extracranial headache involving terminal branches of sensory nerves
Clinical manifestations:
- mild-to-moderate pressure-like pain in a rounded or elliptical area 2-6 cm in diameter typically in the parietal area
- localization of pain in fixed in position & size
- pain is continuous with exacerbations lasting seconds to 2 hours
- may be chronic or remitting
- affected area may show hypoethesia, dysesthesia, paresthesia &/or tenderness
- physical examination is normal
Radiology:
- neuroimaging is warranted in all patients to rule out secondary causes especially pituitary lesions [2]
Management:
- treatment is seldom necessary
- gabapentin, tricyclic antidepressants & botulinum toxin may be beneficial
- case reports of nummular headache reponding to surgical intervention or occuring postoperatively [2]
General
headache
References
- Pareja JA, Pareja J.
Nummular headache: diagnosis and treatment.
Expert Rev Neurother. 2003 May;3(3):289-92
PMID: 19810895
- Holle D, Obermann M
Rare Primary Headaches.
Curr Opin Neurol. 2014;27(3):332-336.
PMID: 24792342
http://www.medscape.com/viewarticle/825192_9