Bifocal Nummular Headache: A Series of 6 New Cases

Authors

  • Ángel L. Guerrero MD,

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  • María L. Cuadrado MD, PhD,

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • María E. García-García MD,

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • Elisa Cortijo MD,

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • Sonia Herrero-Velázquez MD, PhD,

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • Octavio Rodríguez MD,

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • Patricia Mulero MD,

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • Jesús Porta-Etessam MD

    1. From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).
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  • Partially presented as a Poster at the II European Headache and Migraine Trust International Congress (EHMTIC), Nice, October 2010.

  • Conflict of Interest: None

A.L. Guerrero, Neurology Department. Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain; email: gueneurol@gmail.com

Abstract

(Headache 2011;51:1161-1166)

Objective.— We aimed to report 6 new cases of bifocal nummular headache (NH), showing their clinical characteristics and comparing them with those formerly described.

Background.— NH is a focal head pain felt in a small, well-circumscribed, coin-shaped area. Among all the reported cases (over 200), 6 patients localized their pain in 2 or more separate areas.

Methods.— We reviewed all patients diagnosed with NH at the headache clinics of 2 tertiary hospitals, searching for cases with head pain in 2 different areas.

Results.— Six patients (4 female, 2 male; age at onset 40.8 ± 19.1, range 24-69 years) presented with bifocal NH. The shape and size of both painful areas were identical in each patient. They were located at symmetrical points of either side in 3 patients, while 2 patients had both symptomatic areas on the same side of the head. The chronological pattern was synchronous in 2 patients, and the other 4 showed an additive pattern with onset intervals between the 2 areas ranging from 2 months to 30 years. Pain intensity was slightly different in each area in 4 of the cases. Four patients were treated with a preventive (gabapentin or carbamazepine) with good clinical response.

Conclusion.— Although not frequently found, some patients may have bifocal or multifocal NH.

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