Symptoms and Treatment of a Nummular Headache

A nummular headache (NH) is a rare type of headache that causes recurring pain in a small, coin-shaped area on one side of the head, usually at the temple. The pain from a nummular headache is perceived by the parietal lobe region of the brain.

This article explains what causes a nummular headache and what parietal pain feels like. It also discusses how this type of headache is diagnosed and treated.

Nummular Headache Symptoms

People with nummular headaches often describe mild to moderate pain; severe pain is rare. The pain is often described as stabbing or pressure-like. A burning feeling may set in as the headache fluctuates in intensity.

Nummular headache pain is usually chronic and can be intermittent or continuous. It can last anywhere from seconds to days, even months.

The pain can be anywhere on the scalp, but is commonly located either at the right or left temples (parietal lobe regions). The pain does not spread and rarely occurs in more than one spot at the same time.

The affected area is circular or oval-shaped and small, ranging in size from about 1 centimeter (roughly the size of a penny) to 6 centimeters (around 2.5 inches). Nummular headaches were once called coin-shaped headaches because of their shape and size.

After the headache stops, some people experience other sensations in the area where they had pain. This might include tingling and numbness. A healthcare provider may be able to reproduce the tenderness when pressing on the area of the head during a physical examination.

Causes of Nummular Headaches

Nummular headaches are extracranial, meaning they stem from tissues and nerves that sit over the skull.

More specifically, researchers think nummular headaches might be caused by irritation or compression of the trigeminal nerves, which run along each side of the head. The three branches of these nerves send sensory signals from the face to the parietal lobe of the brain.

Nummular headaches are considered primary headaches (that is, one that is not a symptom of another problem). However, cases that were associated with other health conditions have been reported.

Some people also start having nummular headaches after a head injury.

There is also a high prevalence of autoimmune disorders in people who experience these headaches.

Around half of those who have been diagnosed with nummular headache also have a diagnosis of some other type of chronic headache, such as migraine or tension headache. The causes of these are not related to NH.

Diagnosis

Nummular headaches are a diagnosis of exclusion, meaning all other—and more common—possibilities are ruled out first.

First, your healthcare provider will perform a physical exam and run tests, which can include:

• Alkaline phosphatase
• Antinuclear antibody
• Complete blood count (CBC)
• Basic metabolic panel
• Erythrocyte sedimentation rate
• Liver function tests
• Rheumatoid (Rh) factor
• Thyroid function tests

If needed, imaging may be ordered to check for nervous system issues:

• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
  

Other Conditions With Similar Symptoms

Accompanying symptoms such as nausea and vomiting, stuffy nose, or sensitivity to light do not occur with nummular headaches like they can with migraines, which can help a healthcare provider differentiate the two.

They will also consider non-headache diagnoses. For example, your scalp will be examined for rashes that could indicate shingles, which can mimic nummular headache pain.

Other conditions that can cause pain similar to nummular headaches that may be considered include:

• Bone infections like osteomyelitis
• Multiple myeloma, a type of blood cancer
• Paget’s disease, which causes accelerated bone growth
• Cancer that has spread (metastatic cancer)

Once other conditions excluded as possibilities, a diagnosis of nummular headache is usually based on specific characteristics of the pain, including:

• Location
• Intensity
• How long it lasts
• How it comes on
  

Nummular Headache Treatment

Unfortunately, no single therapy has proven effective in substantially reducing the severity and/or frequency of nummular headache symptoms. Your healthcare provider may recommend a combination of treatments to help reduce your pain.

Many medications can be used to relieve parietal headache pain. Some of these include:

• Nonsteroidal anti-inflammatories (NSAIDs)
• Neurontin (gabapentin)
• Tricyclic antidepressants like Elavil (amitriptyline)

Botox is an option for treating nummular headaches that do not respond to medication. Botulinum toxin is produced by the Clostridium botulinum bacterium. It works by blocking nerve connections on the scalp.

Research has shown that Botox may start to work six to 10 days after administered and last up to 14 weeks, at which time you would need another injection.

Nerve stimulation and surgery may be considered in select cases.

Can Nummular Headaches Be Prevented?

You can’t always prevent headaches. Treatments for trigeminal neuralgia seem to help with migraines. They could help prevent nummular headaches as well.

Beyond this, the best thing you can do is take care of your health by:

• Getting enough quality sleep
• Finding ways to reduce your stress levels
• Staying active 
• Eating a balanced and nutritious diet
• Staying hydrated with water
• Avoiding anything you notice triggers your headaches
• Quitting smoking or using substances 
• Taking your medications as prescribed by your provider
• Asking your healthcare provider before trying supplements, over-the-counter (OTC), or natural remedies for your symptoms
• Making sure you understand your provider’s recommendations and treatment plan 
• Working with a physical therapist
• Exploring other treatments like acupuncture and pressure points
• Staying up to date with preventive care like annual wellness visits, vaccinations, and health screenings
• Reaching out for support from family and friends, a mental health professional, or a support group

Summary

Nummular headaches affect a small area of the head, typically the parietal region, which is behind and above the temple. Pain is usually mild to moderate, but can be brief or long-lasting. This is considered a chronic headache disorder.

This type of headache is rare and is thought to be related to irritation of certain nerves.

Diagnosis nummular headache can take time, as other possibilities must be ruled out first.