Baldelli Ilaria, Lucia Mangialardi Maria, Salgarello Marzia, Raposio Edoardo
Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate-DISC, Università degli Studi di Genova, Genova, Italy.
Istituto di Clinica Chirurgica, Dipartimento Scienze della Salute della Donna e del Bambino, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Plast Reconstr Surg Glob Open. 2020 Jul 28;8(7):e2989. doi: 10.1097/GOX.0000000000002989. eCollection 2020 Jul.
Nummular headache (NH) is an uncommon primary headache characterized by pain limited to a precise small area of the scalp. There is no global consensus on its pathogenesis, but its extracranial origin is the most accepted theory. Moreover, peripheral mechanism is supported by the overlapping symptomatology of secondary forms of NH and is well described in the literature. However, a standard effective treatment is still lacking.
A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to evaluate surgical strategies for NH. Inclusion criteria were English language, diagnosis of primary NH according to International Classification of Headache Disorders, 3rd Edition, or of secondary NH, and follow-up at a minimum of 3 months. The treatment had to consist of peripheral surgery.
One hundred eighty-seven records were identified after duplicates were removed, 15 full-text articles were assessed for eligibility, and 4 records were selected for inclusion. A total of 53 patients were included in this review, 50 of whom were diagnosed with primary NH. The general positive response after surgery (>50% reduction in occipital migraine headaches) was about 70.0% for primary NH, while secondary NH always showed complete pain relief. However, many variations in patient selection and type of surgery were described.
Neurovascular relationship in the extracranial tissues seems to be involved in the onset of NH. However, only limited data from meager literature and from few patients are currently available. Shared multicentric research protocols are badly required.
钱币状头痛（NH）是一种罕见的原发性头痛，其特征是疼痛局限于头皮的一个精确小区域。关于其发病机制尚无全球共识，但其颅外起源是最被接受的理论。此外，NH继发性形式的重叠症状支持外周机制，且在文献中有详细描述。然而，仍然缺乏标准的有效治疗方法。
根据系统评价和荟萃分析的首选报告项目指南进行文献检索，以评估NH的手术策略。纳入标准为英文文献、根据《国际头痛疾病分类》第三版诊断为原发性NH或继发性NH，以及至少3个月的随访。治疗必须包括外周手术。
去除重复记录后共识别出187条记录，评估了15篇全文文章的 eligibility，选择了4条记录纳入。本综述共纳入53例患者，其中50例被诊断为原发性NH。原发性NH手术后的总体阳性反应（枕部偏头痛头痛减少>50%）约为70.0%，而继发性NH总是显示疼痛完全缓解。然而，描述了患者选择和手术类型的许多变化。
颅外组织中的神经血管关系似乎与NH的发病有关。然而，目前仅有来自少量文献和少数患者的有限数据。迫切需要共享的多中心研究方案。
