Rammohan K, Mundayadan Shyma M, Mathew Robert
Department of Neurology, TD Medical College Hospital, Alappuzha, Kerala, India.
Department of Neurology, PVS Memorial Hospital, Kochi, Kerala, India.
J Neurosci Rural Pract. 2016 Oct-Dec;7(4):532-536. doi: 10.4103/0976-3147.186984.
Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2-6 cm in diameter.
The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature.
A prospective, observational study conducted in a tertiary care center.
Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient.
A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36-60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia.
Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain.
钱币状头痛（NH）是一种原发性疾病，其特征是头部疼痛仅局限于一个直径通常为2 - 6厘米的小圆形区域。
本综述的目的是研究印度南部患者群体中NH的临床和流行病学特征，并将其与国际文献中描述的特征进行比较。
在一家三级医疗中心进行的前瞻性观察性研究。
对印度南部一家三级转诊医院内科和神经科门诊就诊的患者进行研究，这些患者根据《国际头痛疾病分类第3版β版（2013年）》标准被诊断为患有NH，研究时间为30个月。所有患者的神经系统检查均正常。除1例患者外，神经影像学检查结果均正常。
共研究了19名女性和10名男性。平均发病年龄为47.62岁（范围36 - 60岁）。头痛持续时间从最短3个月到最长5年不等，平均为24.17个月。头痛部位主要在顶叶区域，共15例（51.72%），其次是枕叶区域，共7例（24.13%）。受累区域的平均直径为3.23厘米。头痛强度为轻度至中度，平均视觉模拟量表评分为5.03。疼痛性质主要为烧灼样感觉异常，共12例（41.38%）。在大多数患者中，即21例（72.41%），疼痛为慢性且持续。尽管少数患者（9例，31.03%）报告有感觉异常、感觉迟钝和痛觉过敏，但没有患者出现任何明显的营养改变。只有1例（3.45%）患者有头部受伤史。29例患者中有10例（34.48%）患有其他类型的并发头痛；其中大多数被证明是偏头痛，即7例（24.14%），2例（6.89%）为紧张性头痛，1例（3.45%）为三叉神经痛。
我们的研究证明了在印度南部人群中存在新描述的原发性头痛综合征NH。将我们的结果与国际文献进行比较，相似之处远多于差异。我们系列中疼痛的病因似乎主要是外周性的，在某些情况下，由于多种并发的中枢性头痛原因，中枢性疼痛敏化也起了作用。
