[Nummular headache: clinical features and therapeutic experience in a series of 30 new cases]

Abstract

Introduction: Nummular headache (NH) is a mild or moderate pain, located in a small, well circumscribed, rounded or elliptical area. Temporal pattern is variable and pain exacerbations have been described. AIM. To analyze clinical characteristics and therapy requirement and response in a series of patients attended due to NH in a headache outpatient office.

Patients and methods: 30 patients (18 females, 12 males) diagnosed as NH. We considered demographic and nosological characteristics, temporal pattern, presence and intensity of exacerbations, and requirement of symptomatic or preventive therapies.

Results: Age at onset 49.2 ± 18.1 years (range: 21-79 years). Two of the patients presented a bifocal NH and we analyzed 32 areas, 28 rounded and 4 elliptical. Diameter: 4.7 ± 1.1 cm. Regarding locations occipital (10 areas, 31.3%), parietal (9 areas, 28.1%) and frontal (6 areas, 18.8%). Pain intensity of 5.2 ± 1.8 on a ten-point visual analogical scale. Regarding temporal profile, in 18 areas (56.3%) was chronic, in 5 (15.6%) episodic and undefined due to a scarce time from onset in 9 (28.1%). In 16 areas (50%) pain exacerbations lasting from 3 seconds to 15 minutes occurred. Nine (30%) patients did not improve with symptomatic drugs, and at least one preventative was prescribed in 23 (76.6%) patients without consistent effectiveness.

Conclusions: NH is not an uncommon diagnosis in an outpatient headache office. In our series, basal pain intensity is moderate and symptomatic drugs commonly provide no relief. So, patients frequently need a preventive therapy.