Clinical characteristics of nummular headache and differentiation between spontaneous and posttraumatic variant: an observational study

Javier Trigo, David García-Azorín, Enrique Martinez Pias, Álvaro Sierra, Alba Chavarría, Angel Luis Guerrero, Javier Trigo, David García-Azorín, Enrique Martinez Pias, Álvaro Sierra, Alba Chavarría, Angel Luis Guerrero

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.

Keywords: Allodynia; Cranial trauma; Nummular headache; Precipitants.

Conflict of interest statement

The authors declare not to have any competing interest.

Figures

Fig. 1
Fig. 1
Time to diagnosis. Percentage of patients that have been diagnosed at each given point (y-axis). X-axis represents the time in months to diagnosis
Fig. 2
Fig. 2
Clinical response to gabapentine. Blue bars: > 50% response, orange bars: 30–50% response, red bars: no response. Percentage represents % of patients treated with gabapentine

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Source: PubMed

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