From the Research
Nummular headache treatment should prioritize botulinum toxin type A (BoNT-A) as the most effective intervention, with a response rate of 100%, as evidenced by the most recent and highest quality study 1.
Treatment Overview
Nummular headache is a primary headache disorder characterized by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp. The treatment approach should focus on addressing the presumed pathophysiology of nummular headache, which involves localized irritation or dysfunction of sensory nerves in the scalp.
First-Line Treatment
The most effective first-line treatment for nummular headache is botulinum toxin type A (BoNT-A), with a response rate of 100% 1. This is supported by the latest systematic review and analysis of 110 cases, which found that BoNT-A was the most effective intervention for achieving complete resolution of the headache.
Alternative Treatments
Other treatment options, such as gabapentin, non-steroidal anti-inflammatory drugs (NSAIDs), and tricyclic antidepressants, may also be effective, but with lower response rates compared to BoNT-A 1. Gabapentin, for example, has a response rate of 67.7%, while NSAIDs have a response rate of 65.6% 1.
Lifestyle Adjustments
In addition to medication, lifestyle adjustments, such as identifying and avoiding triggers, applying warm or cold compresses to the affected area, and stress management techniques, can complement medication therapy and improve treatment outcomes.
Key Considerations
Younger patients, female sex, and early diagnosis are associated with complete resolution of nummular headache 1. Regular follow-up is important to assess treatment response and adjust the regimen as needed. The treatment approach should be individualized based on the patient's specific needs and circumstances.