What is a Nummular Headache?

Symptoms, Diagnosis, and Treatment of a Coin-Shaped Head Pain

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Nummular headache—often located in the parietal region of the head—is a rare type of headache that causes a sharp or stabbing, coin-shaped pain of the scalp. 

Symptoms of a Nummular Headache

The pain of a nummular headache is usually chronic occurring in a circular or elliptical shaped area of the scalp. It's a fixed sort of pain, meaning that the shape and size of the area of pain remains stable. The area of pain ranges in size from about 1cm (a penny) to 6 cm (a lime).

While a nummular headache may occur anywhere on the scalp, it's most commonly found on the sides of the head—an area called the parietal region. Rarely does a nummular headache exist on both sides of the head, and also rarely does a person have multiple nummular headaches (or multiple sites of coin-shaped head pain). 

People with nummular headaches often describe a mild to moderate pain intensity, but they can be severe. The pain is often described as stabbing or pressure-like. Some people too note abnormal sensations in this area like tingling, numbness, or allodynia, especially when the headache remits. Also, a doctor may be able to reproduce the tenderness when pressing on the area during a physical examination.

Diagnosis of a Nummular Headache

In order for a nummular headache to be diagnosed, a doctor will usually order Imaging of the brain with a computed tomography scan (CT scan) or a magnetic resonance imaging (MRI).

This will ensure that there is no other cause for the headache, especially due to the rarity of nummular headaches. Your doctor will also carefully examine your scalp to make sure there is no rash, as herpes zoster can mimic the pain of a nummular headache. 

Serious causes of a headache that may mimic nummular headaches include:

• Metastatic Cancer

• Bone Infection like Osteomyelitis

Multiple Myeloma

Paget’s Disease

Cause of Nummular Headaches

The likely cause is a localized irritation or neuralgia of one of the branches of the trigeminal nerve, a nerve located in the facial area. There may also be a connection between nummular headaches and migraines.

Treatment of Nummular Headaches

Many different medications—like non-steroidal anti-inflammatories (NSAIDs) and gabapentin—may be used to try and relieve a person's nummular headache. Tricylic antidepressants like Elavil (amitriptyline) may also be helpful. That being said, there is no single therapy that has been found to be substantially effective in treating nummular headaches, according to a 2010 study in Cephalalgia.

Botox may also be an option. Botulinum toxin is a toxin produced by the bacteria Clostridium botulinum and works by blocking nerve connections It was approved in October 2010 by the FDA for the treatment of chronic migraine.

A Word from Verywell

Due to the rarity of nummular headaches, be sure to get properly evaluated by a doctor if you suspect this diagnosis.

More than likely, your doctor will perform a thorough scalp and head physical examination and recommend brain imaging to rule out other causes.

Sources:

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808

Mathew NT, Kailasam J, Meadors L. Botulinum toxin type A for the treatment of nummular headache: four case studies. Headache. 2008 Mar;48(3):442-7.

Moon J, Ahmed K, Garza I. Case series of sixteen patients with nummular headache. Cephalalgia. 2010 Dec;30(12):1527-30.

Schwartz DP, Robbins MS, Grosberg BM. Nummular headache updateCurr Pain Headache Rep. 22013 Jun;17(6):340.

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