Symptoms and Treatment of a Nummular Headache

What this headache often feels like

Table of Contents
View All
Table of Contents

Nummular headache is a headache that causes continuous pain in a small, coin-shaped part of the head. Typically, this is a 1 to 6 cm sized area of the parietal lobe on one side at the temple. The pain associated with a nummular headache is called parietal pain.

Nummular headaches are rare. They may be caused by irritation of one of the trigeminal nerve branches that carry sensory signals from the face to the brain. There may also be a connection between nummular headaches and migraines. Some people experience nummular headaches after a head injury.

This article explains what causes a nummular headache and what parietal pain feels like. It also discusses how parietal headaches are diagnosed and treated.

A woman at work suffering from a headache
JGI / Jamie Grill / Getty Images

Nummular Headache Symptoms

Nummular headache pain is usually chronic, meaning it happens intermittently in the same spot anywhere on the scalp. It does not spread to other sites.

These headaches are considered primary headaches, meaning that a parietal headache is not the sign of a stroke or other condition, though some cases associated with other health conditions have been reported.

They are commonly found on either the right side or left side of the head in areas known as the parietal lobe regions. The spot is a small circle or oval, with the parietal headache location staying fixed. The area ranges in size from about 1 centimeter (roughly the size of a penny) to 6 centimeters (around 2.5 inches).

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 note other sensations in the area of pain, including tingling and numbness after the headache stops. A healthcare provider may be able to reproduce the tenderness when pressing on the area during a physical examination.

Parietal Head Pain

Rarely does a nummular headache occur on both sides of the head or affect more than one site on the scalp at the same time. It's typically always in the same spot, often described as a stabbing pain, and may be associated with numbness and tingling at the site.

Diagnosing Parietal Headache

In order for a nummular headache to be diagnosed, a healthcare provider will usually order imaging of the brain with a computed tomography (CT) scan or 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 healthcare provider will carefully examine the scalp to make sure there are no rashes, such as those caused by shingles, that can mimic nummular headache pain. Other conditions that can mimic nummular headaches include:

Nummular Headache Treatment

Many different medications like non-steroidal anti-inflammatories (NSAIDs) and Neurontin (gabapentin) may be used to try and relieve a person's parietal headache pain. Tricyclic antidepressants like Elavil (amitriptyline) are often effective. Nerve blocks in the area can also be helpful.

Botox may be an option for treating nummular headaches, mostly if they do not respond to medication. Botulinum toxin is produced by the Clostridium botulinum bacterium and works by blocking nerve connections on the scalp. It was approved by the Food and Drug Administration (FDA) in 2010 for the treatment of chronic migraine.

Despite the plethora of treatment options, no single therapy has proven effective in substantially reducing the severity and/or frequency of nummular headache symptoms.

Nummular Headache and Trigeminal Nerves

The trigeminal nerves run on other side of the face and give it sensation. These cranial nerves have three branches, with the ophthalmic nerve feeding the eye and forehead, and the others reaching the nose, cheeks, mouth and jaw. Pain, or neuralgia, in the nerve is thought to be a possible cause of nummular headache, due to nerve compression or irritation.

A Word From Verywell

Due to the rarity of nummular headaches, be sure to get it properly evaluated by a healthcare provider if you suspect this diagnosis. More than likely, your practitioner will perform a thorough scalp and head physical examination and recommend brain imaging to rule out other causes.

Frequently Asked Questions

  • How rare is parietal headache pain?

    True cases of nummular headache occur in about six out of every 100,000 people. This can make the diagnosis and treatment challenging. Researchers who studied 110 cases found that successfully treated people were more likely to have received botulinum toxin (botox) and gabapentin.

  • Is parietal headache pain sharp?

    Parietal headache pain has been described as a severe stabbing or sharp pain. Burning or a “wound-like” pain in the scalp occurs as the headache fluctuates in intensity.

  • Is parietal headache pain a sign of stroke?

    A parietal headache is not considered to be a symptom of an underlying medical condition like stroke. Symptoms of some conditions can mimic those of parietal headache. Severe head pain should be evaluated by a healthcare provider to rule out other serious or life-threatening causes.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Thomas DC, Heir GM, Patil AG, Soni PK. Nummular Headache - a Case Report of a Rare Entity. Curr Pain Headache Rep. 2020 Oct 12;24(11):71. doi:10.1007/s11916-020-00901-8

  2. Wilhour D, Ceriani CEJ, Nahas SJ. Nummular HeadacheCurr Neurol Neurosci Rep 19, 26 (2019). doi:10.1007/s11910-019-0943-x

  3. Patel UK, Saleem S, Anwar A, Malik P, Chauhan B, Kapoor A, et al. Characteristics and treatment effectiveness of the nummular headache: a systematic review and analysis of 110 cases. BMJ Neurol Open. 2020 Mar 12;2(1):e000049. doi:10.1136/bmjno-2020-000049.

  4. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders: 3rd Edition (beta version)Cephalalgia 2013;33(9):629-808. doi:10.1177/0333102413485658

  5. Trigo J, García-Azorín D, Martinez Pias E, Sierra Á, Chavarría A, Guerrero AL. Clinical characteristics of nummular headache and differentiation between spontaneous and posttraumatic variant: an observational study. J Headache Pain. 2019;20(1):34. doi:10.1186/s10194-019-0981-4

  6. Schwartz DP, Robbins MS, Grosberg BM. Nummular headache update. Curr Pain Headache Rep. 2013;17(6):340. doi:10.1007/s11916-013-0340-0

  7. Escher CM, Paracka L, Dressler D, Kollewe K. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord. 2017;10(2):127-135. doi:10.1177/1756285616677005

  8. American Association of Neurological Surgeons. Trigeminal Neuralgia.

  9. Martins IP, Abreu L. Nummular headache: Clinical features and treatment response in 24 new casesCephalalgia Reports. 2018;1:251581631880277. doi:10.1177/2515816318802771

Additional Reading

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.