Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Headache. 2019 Apr;59(4):593-602. doi: 10.1111/head.13503. Epub 2019 Mar 14.
To report 2 new nummular headache (NH) cases and review the clinical features and management of NH.
NH is a coin-shaped headache with a fixed shape and size. Since the first case series was reported by Pareja, approximately 300 cases have been reported. However, the latest treatment status and pathogenesis of NH remain unclear.
Two new NH cases with improved symptomatic responses to metoprolol were reported. We also conducted a narrative review of cases published in English aiming to provide the newest information about the clinical features and management of NH.
Two NH patients with skin depressions within the painful area experienced significantly improvement with metoprolol. The literature review showed that NH was mainly moderate-to-severe in 77.8% (186/239) of the patients. Sensory dysfunction and focal trophic changes were reported in 47.8% (149/312) and 3.8% (12/312) of the patients, respectively. Gabapentin was the most commonly used and effective prophylactic, with a responder rate of 67.9% (55/81). Botulinum toxin type A was used for refractory NH, with an effective rate of 81.8% (9/11). Ten patients from the previous studies were prescribed β-adrenergic blockers without any relief, and none of them reported focal tropic changes.
NH can be a disabling headache in more than half of identified patients and requires medical intervention. As with the previous treatment recommendations, gabapentin was the most commonly used prophylactic with a good response. Our cases suggested that β-adrenergic blockers could be a therapeutic option for NH patients with focal trophic changes within the areas.
报告 2 例新的钱币状头痛（NH）病例，并回顾 NH 的临床特征和治疗方法。
NH 是一种硬币状头痛，形状和大小固定。自 Pareja 首次报告首例病例系列以来，约有 300 例病例报告。然而，NH 的最新治疗状况和发病机制仍不清楚。
报告了 2 例新的 NH 病例，这些病例对美托洛尔的症状反应得到改善。我们还对以英语发表的病例进行了叙述性综述，旨在提供关于 NH 的临床特征和治疗的最新信息。
2 例 NH 患者的疼痛区域内有皮肤凹陷，美托洛尔治疗后症状明显改善。文献综述显示，77.8%（186/239）的患者的 NH 主要为中重度。47.8%（149/312）和 3.8%（12/312）的患者分别有感觉功能障碍和局灶性营养障碍。加巴喷丁是最常用和有效的预防药物，应答率为 67.9%（55/81）。A型肉毒毒素用于难治性 NH，有效率为 81.8%（9/11）。以前的研究中有 10 名患者使用β肾上腺素能阻滞剂治疗，但没有任何缓解，并且他们都没有报告局灶性营养障碍。
NH 可引起一半以上患者出现致残性头痛，需要医疗干预。与以前的治疗建议一样，加巴喷丁是最常用的预防药物，反应良好。我们的病例表明，β肾上腺素能阻滞剂可能是局灶性营养障碍的 NH 患者的一种治疗选择。
