Patel Urvish K, Saleem Sidra, Anwar Arsalan, Malik Preeti, Chauhan Bindi, Kapoor Ashish, Arumaithurai Kogulavadanan, Kavi Tapan
Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurology, University of Toledo, Toledo, Ohio, USA.
BMJ Neurol Open. 2020 Mar 12;2(1):e000049. doi: 10.1136/bmjno-2020-000049. eCollection 2020.
BACKGROUND/OBJECTIVE: Nummular headache (NH) is a primary headache disorder characterised by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp. As there are limited data in the literature on NH, we conducted this review to evaluate demographic characteristics and factors associated with complete resolution of the headache, and effectiveness of treatment options.
We performed a systematic review of cases reported through PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and 'nummular headache', 'coin-shaped headache' and 'coin-shaped cephalalgia' keywords. Analysis was performed by using χ test and Wilcoxon rank-sum test. For individual interventions, the response rate (RR%) of the treatment was calculated.
We analysed a total of 110 NH cases, with median age 47 years and age of pain onset 42 years. Median duration to make correct diagnosis was 18 months after first attack. The median intensity of each attack was 5/10 on verbal rating scale over 4 cm diameter with duration of attack <30 min. Patients with NH had median three attacks per day with frequency of 9.5 days per month. 40 (57.97%) patients had complete resolution of the headache after treatment. Patients with complete resolution were younger, more likely to be female, and were more likely to have diagnosis within year. Patients with complete resolution more likely to have received treatment with onabotulinum toxin A (botulinum toxin type A (BoNT-A)), and gabapentin compared with patients without complete resolution. Most effective interventions were gabapentin (n=34; RR=67.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (n=32; RR=65.6%), BoNT-A (n=12; RR=100%) and tricyclic antidepressant (n=9; RR=44.4%).
Younger patients, female sex and early diagnosis were associated with complete resolution. NSAIDs, gabapentin and BoNT-A were most commonly used medications, with significant RRs.
背景/目的：钱币状头痛（NH）是一种原发性头痛疾病，其特征为间歇性或持续性头皮疼痛，影响头皮上一个小的局限性区域。由于关于NH的文献资料有限，我们进行了这项综述，以评估人口统计学特征、与头痛完全缓解相关的因素以及治疗方案的有效性。
我们使用系统评价和Meta分析的首选报告项目协议以及“钱币状头痛”“硬币状头痛”和“硬币状头痛症”等关键词，对通过PubMed数据库报告的病例进行了系统评价。采用χ检验和Wilcoxon秩和检验进行分析。对于个体干预措施，计算治疗的有效率（RR%）。
我们共分析了110例NH病例，中位年龄47岁，疼痛发作年龄42岁。首次发作后做出正确诊断的中位时间为18个月。每次发作的中位强度在言语评定量表上为5/10，直径超过4厘米，发作持续时间<30分钟。NH患者每天发作次数的中位数为3次，每月发作频率为9.5天。40例（57.97%）患者治疗后头痛完全缓解。完全缓解的患者更年轻，更可能为女性，且更可能在1年内得到诊断。与未完全缓解的患者相比，完全缓解的患者更可能接受了A型肉毒毒素（肉毒毒素A（BoNT-A））和加巴喷丁治疗。最有效的干预措施为加巴喷丁（n = 34；RR = 67.7%）、非甾体抗炎药（NSAIDs）（n = 32；RR = 65.6%）、BoNT-A（n = 12；RR = 100%）和三环类抗抑郁药（n = 9；RR = 44.4%）。
年轻患者、女性和早期诊断与完全缓解相关。NSAIDs、加巴喷丁和BoNT-A是最常用的药物，有效率显著。
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