From the Guidelines
Nummular headache treatment should prioritize medications that target migraine prevention, given the similarities in pathophysiology, with candesartan or telmisartan being recommended for the prevention of episodic migraine 1.
Treatment Approach
When managing nummular headaches, it's essential to consider the latest guidelines for migraine treatment, as the condition shares some similarities with migraine. The 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache recommends:
- Candesartan or telmisartan for the prevention of episodic migraine 1.
- Erenumab, fremanezumab, or galcanezumab for the prevention of episodic or chronic migraine 1.
Pharmacotherapy
For acute episodes, the following medications may be considered:
- Eletriptan, frovatriptan, rizatriptan, sumatriptan (oral or subcutaneous), the combination of sumatriptan and naproxen, or zolmitriptan (oral or intranasal) for the short-term treatment of migraine 1.
- Aspirin-acetaminophen-caffeine for the short-term treatment of migraine 1.
Additional Considerations
It's crucial to individualize treatment based on symptom severity and consider medication trials lasting 6-8 weeks to assess effectiveness. Local anesthetic injections, nerve blocks, botulinum toxin injections, or neuromodulation techniques may be considered in resistant cases. Topical treatments like capsaicin cream may also provide relief for some patients. Given the lack of specific guidelines for nummular headache, adopting a treatment approach similar to migraine, with a focus on prevention and acute management, is a reasonable strategy 1.
From the Research
Nummular Headache Treatment
- Nummular headache is a rare primary headache disorder characterized by focal and well-circumscribed pain fixed within a round-, oval-, or elliptical-shaped region of the head 2.
- Treatment with gabapentin, tricyclic antidepressants, or botulinum toxin may be helpful for nummular headache 2.
- Botulinum toxin type A (BoNTA) has been shown to be effective in treating nummular headache, with all patients experiencing a reduction in symptoms after treatment 3.
- A systematic review of 110 cases found that the most effective interventions for nummular headache were gabapentin, non-steroidal anti-inflammatory drugs (NSAIDs), BoNT-A, and tricyclic antidepressant 4.
- Surgical treatment may also be an option for nummular headache, with a positive response rate of around 70% for primary nummular headache 5.
Treatment Options
- Gabapentin: effective in treating nummular headache, with a response rate of 67.7% 4.
- Non-steroidal anti-inflammatory drugs (NSAIDs): effective in treating nummular headache, with a response rate of 65.6% 4.
- Botulinum toxin type A (BoNT-A): effective in treating nummular headache, with a response rate of 100% 4.
- Tricyclic antidepressant: effective in treating nummular headache, with a response rate of 44.4% 4.
- Surgical treatment: may be an option for nummular headache, with a positive response rate of around 70% for primary nummular headache 5.
Characteristics of Nummular Headache
- Nummular headache is characterized by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp 4.
- The pain is usually mild to moderate in intensity, but may be severe 2.
- The temporal pattern may be chronic and continuous, or episodic 2.
- Sensory phenomena, such as paresthesias, allodynia, and dysesthesias, are frequently reported in the region of the pain 2.