Nummular headache: 21 new cases and therapeutic results

Abstract

To evaluate the clinical feature of nummular headache and the efficiency of treatment in China. The data of 21 NH patients treated from February 2006 to February 2008, were analyzed. They were 9 men, 12 women, aged 37 +/- 12 (18 - 63) years. Headache history ranged from 7 days to 30 years. 13 patients reported head pain confined to a circular area of 0.6 to 5 centimeter, and the other 8 patients had pain in an elliptical area of 1 - 2 centimeter x 1.5 - 3 centimeter. The symptomatic area was located in the parietal (n = 7), occipital(n = 8), temporal (n = 6), or border regions between temporal and parietal (n = 1). The right side was affected in 10 patients and the left side in the 9 patients, the middle of occipital and parietal areas were affected in 1 patient, respectively. Seven patients had mild pain, 8 patients had moderate pain and 6 patients had severe pain. The characteristics of headache included stabbing pain (n = 6), sharp pain (n = 3), pulsating apin (n = 3), grinding pain (n = 1), exploding pain (n = 5), included light-dull apin (n = 3). Three patients were treated by local nerve block with lidocaine plus dexamethasone phosphate/acetate and one of them got some 30 hours of prominent pain relief, no relief was obtained for other two patients. One patient obtained pain remission by acupuncture after amitriptyline, paroxetine had been tried ineffectively. One patient, woman, 38 years old, was treated by carbamazepine (tegretol) and amitriptyline for 3 months and pain relief was obtained gradually and the head pain disappeared finally. 8 patients were treated effectively by amitriptyline combining indomethacium, ibuprofen or carbamazepine. One patient was treated effectively by nimodipine. 2 patients were treated ineffectively by amitriptyline combining indomethacium. 4 patients were not treated. 3 patients were lost to follow-up. NH is not very rare and some of NH patients may be treated effectively by acupuncture or amitriptyline combining indomethacium, ibuprofen or carbamazepine.