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

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

More general terms

• headache