Clar-de-Alba B, Barriga F J, Rodríguez-Caravaca G
Universidad Rey Juan Carlos, 28922 Alcorcón, España.
Hospital Madrid Montepríncipe, 28660 Boadilla del Monte, España.
Rev Neurol. 2020 Mar 1;70(5):171-178. doi: 10.33588/rn.7005.2019152.
Nummular headache was initially described as an infrequent primary headache characterised by chronic circumscribed mild-to-moderate pain in a small area of the head that may present with exacerbations. Since its initial description, dozens of cases of nummular headache have been reported which broaden the clinical and pathophysiological spectrum.
To review and establish the clinical characteristics of nummular headache, to analyse the epidemiology in our setting and to clarify some unanswered pathophysiological issues.
The study involved 83 cases (42 women and 41 men) who were diagnosed with nummular headache from July 2008 and followed up until 2018 at the Fundacion Alcorcon Hospital. The mean age of onset was 46 years. The time to diagnosis was seven months.
The pain was moderate-intense and oppressive, with exacerbations in 62.5% of cases. The average size of the symptomatic area was 2.4 ± 0.7 cm, with a parietal (47%), temporal (24%), frontal (12%) or occipital (6%) location. It presented a chronic (82%) or episodic (18%) pattern. Symptoms of local sensory dysfunction were observed in 25 patients and three others showed skin alterations. Spontaneous remission was observed in 36% of cases, and the most commonly used drugs were non-steroidal anti-inflammatory drugs, paracetamol and gabapentin. Botulinum toxin was effective.
Nummular headache is a disorder with well-defined characteristics and is considered an entity in its own right. Our data indicate that its origin lies in the epicranial structures. The conjunction of pain, sensory dysfunction and trophic disorders suggests a local form of a complex regional syndrome.
钱币状头痛最初被描述为一种罕见的原发性头痛，其特征是头部小区域出现慢性局限性轻至中度疼痛，可能会有加重情况。自最初描述以来，已报告了数十例钱币状头痛病例，这拓宽了临床和病理生理范围。
回顾并确定钱币状头痛的临床特征，分析我们研究环境中的流行病学情况，并阐明一些未解决的病理生理问题。
该研究纳入了83例患者（42名女性和41名男性），这些患者于2008年7月被诊断为钱币状头痛，并在阿尔科孔基金会医院随访至2018年。平均发病年龄为46岁。诊断时间为7个月。
疼痛为中度至重度且有压迫感，62.5%的病例有加重情况。症状区域的平均大小为2.4±0.7厘米，位于顶叶（47%）、颞叶（24%）、额叶（12%）或枕叶（6%）。呈现慢性（82%）或发作性（18%）模式。25例患者观察到局部感觉功能障碍症状，另外3例有皮肤改变。36%的病例出现自发缓解，最常用的药物是非甾体抗炎药、对乙酰氨基酚和加巴喷丁。肉毒杆菌毒素有效。
钱币状头痛是一种具有明确特征的疾病，被认为是一种独立的病症。我们的数据表明其起源于颅顶结构。疼痛、感觉功能障碍和营养障碍的结合提示了一种复杂区域综合征的局部形式。
