What Is a Nummular Headache?

Nummular headache, often located in the parietal region of the head, is a rare type of headache that it is a type of headache that is characterized by pain in a coin-shaped region of the scalp. The likely cause of a nummular headache is a localized nerve irritation (neuralgia) of one of the branches of the trigeminal nerve, which carries 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 head trauma.

A woman at work suffering from a headache
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Nummular Headache Symptoms

The pain of a nummular headache is usually chronically occurring in a circular or elliptically shaped area of the scalp. It's a fixed sort of pain, meaning that the shape and size of the area of pain remain stable. The area of pain ranges in size from about 1 centimeter (roughly the size of a penny) to 6 centimeters (around 2.5 inches).

While a nummular headache may occur anywhere on the scalp, it's most commonly found on the sides of the head in an area known as the parietal region.

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.

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


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:

  • Metastatic cancer
  • Bone Infections like osteomyelitis
  • Multiple myelomas
  • Paget’s disease


Many different medications like non-steroidal anti-inflammatories (NSAIDs) and Neurontin (gabapentin) may be used to try and relieve a person's nummular headache. 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.

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.

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5 Sources
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  2. 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

  3. 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

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

  5. 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

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