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Nummular headache

F Michael Cutrer, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Nummular headache is one of several relatively uncommon headache syndromes that may occur either as a primary headache or as a headache symptomatic of potentially malignant processes. Careful evaluation for underlying causes is important for these uncommon types of headache.

This topic will review nummular headache. Other types of uncommon primary headache disorders are discussed separately. (See "Primary stabbing headache" and "Primary cough headache" and "Exertional headache" and "Primary headache associated with sexual activity" and "Approach to the patient with thunderclap headache" and "Hypnic headache".)


Also called coin-shaped headache, nummular headache is characterized by small circumscribed areas of continuous pain on the head [1,2]. Nummular headaches are generally of mild to moderate intensity and confined to a round or elliptical unchanging area 2 to 6 cm in diameter. The pain is continuous, although in a large minority of cases, spontaneous remissions lasting weeks to months may occur. Superimposed on the continuous pain, lancinating pain may occur that initially lasts seconds but may gradually increase in duration to minutes or hours [1,3,4]. During remissions, the affected area may continue to be allodynic, paresthetic, or hyperesthetic [2]. The parietal region is the area of scalp most often affected [5].

While nummular headache is typically unifocal, a few patients have been reported with focal head pain in two separate areas [4,6]. One series of 16 patients with nummular headache found a disproportionately high occurrence of comorbid migraine (56 percent) [7].

Nummular headache is not accompanied by nausea, vomiting, light or sound sensitivity, rhinorrhea, lacrimation, conjunctival injection, or focal neurologic symptoms.

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Literature review current through: Nov 2017. | This topic last updated: Dec 15, 2016.
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  1. Pareja JA, Caminero AB, Serra J, et al. Numular headache: a coin-shaped cephalgia. Neurology 2002; 58:1678.
  2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  3. Pareja JA, Pareja J, Barriga FJ, et al. Nummular headache: a prospective series of 14 new cases. Headache 2004; 44:611.
  4. Guerrero AL, Cortijo E, Herrero-Velázquez S, et al. Nummular headache with and without exacerbations: comparative characteristics in a series of 72 patients. Cephalalgia 2012; 32:649.
  5. Schwartz DP, Robbins MS, Grosberg BM. Nummular headache update. Curr Pain Headache Rep 2013; 17:340.
  6. Cuadrado ML, Valle B, Fernández-de-las-Peñas C, et al. Bifocal nummular headache: the first three cases. Cephalalgia 2009; 29:583.
  7. Moon J, Ahmed K, Garza I. Case series of sixteen patients with nummular headache. Cephalalgia 2010; 30:1527.
  8. Alvaro LC, García JM, Areitio E. Nummular headache: a series with symptomatic and primary cases. Cephalalgia 2009; 29:379.
  9. López-Ruiz P, Cuadrado ML, Aledo-Serrano A, et al. Superficial artery aneurysms underlying nummular headache--2 cases and proposed diagnostic work-up. Headache 2014; 54:1217.
  10. Evans RW, Pareja JA. Nummular headache. Headache 2005; 45:164.
  11. Chen WH, Chen YT, Lin CS, et al. A high prevalence of autoimmune indices and disorders in primary nummular headache. J Neurol Sci 2012; 320:127.
  12. Trucco M, Mainardi F, Perego G, Zanchin G. Nummular headache: first Italian case and therapeutic proposal. Cephalalgia 2006; 26:354.
  13. Baldacci F, Nuti A, Lucetti C, et al. Nummular headache dramatically responsive to indomethacin. Cephalalgia 2010; 30:1151.
  14. Dach F, Speciali J, Eckeli A, et al. Nummular headache: three new cases. Cephalalgia 2006; 26:1234.