Atypical nummular headache or circumscribed migraine: the utility of pressure algometry

Johanna Barón, Cristina Rodríguez, Marina Ruiz, María Isabel Pedraza, Ángel Luis Guerrero, Pascal Madeleine, María Luz Cuadrado, César Fernández-de-Las-Peñas, Johanna Barón, Cristina Rodríguez, Marina Ruiz, María Isabel Pedraza, Ángel Luis Guerrero, Pascal Madeleine, María Luz Cuadrado, César Fernández-de-Las-Peñas

Abstract

A peripheral mechanism has been proposed for nummular headache; however, there have been descriptions of atypical features resembling migraine. The authors describe a case in which algometry assessment facilitated the discrimination between atypical nummular headache and circumscribed migraine. A 21-year-old woman presented with a history of focal episodic pain in a circumscribed area on the left frontal region. The algometry study showed a unilateral and diffuse decrease of the pain pressure thresholds with frontal predominance, as has been proposed for migraine patients. This result led the authors to introduce a more specific preventive therapy with topiramate, with significant relief. In conclusion, cartographic investigation of pressure pain sensitivity is a simple tool that can help to differentiate between nummular headache and migraine. Further confirmatory investigations are needed.

Figures

Figure 1)
Figure 1)
Map of the spatial distribution of pressure pain sensitivity

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Source: PubMed

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