Bifocal pain in nummular headache: A clinical analysis and literature review
- Author:
Yi-Ting Chen
;
Chiu-Hsien Lin
;
Tzu-Hui Li
;
Lian-Hui Lee
;
Wei-Hsi Chen
- Publication Type:Journal Article
- From:Neurology Asia
2013;18(1):59-63
- CountryMalaysia
- Language:English
-
Abstract:
Background: Nummular headache is a new category of primary headache disorder characterized by
consistent location, size, and shape of painful areas. The pathogenesis is uncertain. Bifocal painful
areas are rare manifestations but may expand the clinical diversity of nummular headache. Methods:
The clinical characteristics of 5 bifocal nummular headache patients were reported and those of 11
patients in previous studies were reviewed. Bifocal nummular headache was classifi ed into two types.
Type I was defi ned as a simultaneous activation of two painful areas while type II was defi ned as
two painful areas occurring in different times. Results: All 16 patients were female, with mean age
of onset and initial presentation of 54.7 years and 58.2 years, respectively. There were seven type
I and nine type II patients. The parietal area, especially the tuber parietale, was the leading site of
involvement in both types of patients. The shape and size of painful areas were also similar between
these two groups. There was an equal frequency of ipsilateral and contralateral painful areas. The pain
intensity was similar in both types of patients but was milder in new painful areas than in previous
painful areas in type II patients.
Conclusions: Bifocal nummular headache suggests a central role of nummular headache but does not
debunk the peripheral theory of nummular headache. The accumulated fi ndings in bifocal NH patients
do not support a generalization of pain occurrence or a reproduction of local process of epicranial
neuralgia at multiple sites in nummular headache.
- Full text:P020150703593363144201.pdf
