What Is a Nummular Headache?

A woman at work suffering from a nummular headache
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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.

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.

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 doctor may be able to reproduce the tenderness when pressing on the area during a physical examination.

Diagnosis

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 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

Treatment

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) may also be helpful. 

Botox may also 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 scalps. It was approved by the U.S. Food and Drug Administration (FDA) in October 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, according to a 2012 study in the journal Cephalalgia.

A Word From Verywell

Due to the rarity of nummular headaches, be sure to get it 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.

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