Nummular headache: obeservational cohort study

Background. Nummular headache is one of the rare types of primary cephalgia, characterized by pain in a limited area of a round or oval shape on the scalp. The pathogenesis of the disease is not well understood, the treatment has not been developed. Objective. Evaluation of the clinical features of nummular headache and treatment options. Methods. Observational cohort study included6 patients with nummular headache aged from 24 to 67 years. Half of the patients were treated with gabapentin for 21 days. Results. Among the patients with nummular headache women were prevalent (5 of 6). In all cases, the pain was localized in the parietal region of the scalp and was categorized by patients as intense (7-8 points according to the Numerical Rating Scale). In three cases an increased level of anxiety was observed; in three patients the disease was comorbid with vascular pathology (arterial hypertension, atherosclerosis of the brachiocephalic arteries). Some patients had sensitive disorders in the area of pain, and for their registration we proposed a mapping study of pain sensitivity on the scalp skin. As a result of treatment with gabapentin, regression or a significant reduction in pain is noted. Conclusion. The pathogenesis of nummular headache is currently unknown; its possible neuropathic genesis is being actively studied. Given the role of central sensitization in the pathogenesis of this type of cephalgia, the presence of clinical features of peripheral neuropathic pain, treatment with anticonvulsants, in particular, gabapentin, in the form of a short course is justified.

nummular headache, cephalgia, anticonvulsants, gabapentin