Nummular Headache (Clinical Observation, Discussion)

Abstract

The purpose of the study was to show the importance of using international diagnostic criteria of headache in neurological practice through description of clinical case of nummular headache. Materials and methods. Complaints, medical history, life history, results of objective and neurological examination, data of laboratory and instrumental research methods in a patient with nummular headache. Results and discussion. Patient G., 53 years old, complained of constant, dull, local, moderate pain in the right parietal area. The headache appeared gradually 5–6 months ago, without any evident triggers. Patient denied autonomic trigeminal signs, nausea, photo- and phonophobia. Painkillers intake was accompanied by a temporary slight decrease of headache intensity. At examination patient pointed to local pain area in the right parietal region that had diameter about 3 cm, rounded shape and clear borders. Neurological status – without abnormalities, except for hyperalgesia in the pain area. The skin and hair in the pain area were not changed, touching the skin in this place caused unpleasant feeling. General and biochemical blood tests, blood glucose, general urine analysis were within reference values; magnetic resonance imaging of the brain was without abnormalities; magnetic resonance imaging of the cervical spine showed osteochondrosis, protrusion of intervertebral discs C5-C6, C6-C7. Additional examination was recommended to the patient: computer tomography of the head (skull bones were unchanged), consultation of a dermatologist (no pathology was found). Finally, it was concluded that patient's condition, according to the international classification of headache disorders of the 3rd revision, corresponds to the diagnosis of “nummular headache”. Gabapentin was prescribed 300 mg per day, followed by increasing of the drug dose by 300 mg every 3 days to a daily dose of 1200 mg or until a significant reduction (disappearance) of headache occurred at the lower gabapentin doses. After 1 week of gabapentin taking, patient reported significant decrease in headache intensity at a daily dose of 600 mg with subsequent headache disappearance at a daily dose of 900 mg. It was recommended to continue gabapentin taking at a dose of 900 mg per day for the next 3 months. After 3 months, the patient reported no headache during the entire period of gabapentin usage. It was recommended to reduce the daily dose of gabapentin by 300 mg every 5 days until the headache recurs or until total discontinuation of drug intake. 1 month later the patient reported no headache since stopping gabapentin intake. Conclusion. Neurologists need to know and actively use in their practice the international diagnostic criteria of nummular headache, that is the basis of adequate management of this rare primary headache