What is nummular headache?
So you’ve been told you have a nummular headache. It sounds like a condition straight out of Hogwarts, but it’s a real, rare and distinctive primary headache disorder that stands out for its hallmark feature: localized, coin-shaped pain on the scalp. Unlike the typical, diffuse discomfort of most headaches, this chronic condition creates a sharply contoured area of pain, usually between 1 and 6 centimeters in diameter, most commonly in the parietal (top rear) area of the head. Those affected may experience constant or intermittent pressure, stabbing, or burning sensations within that fixed area, often accompanied by scalp tenderness and unusual touch sensitivity known as allodynia.
The root cause of nummular headache remains an enigma. Although it is classified as a primary headache—meaning no underlying disease is directly responsible—researchers believe there’s a neurological origin involving irritation or dysfunction of small nerves in the scalp. Factors like previous head trauma, local inflammation, autoimmune traits, hormonal fluctuations, and even vascular or psychological influences (such as stress) have all been implicated, though none exclusively.
If nummular headache had an acting career, its most convincing role would be as a migraine impersonator. Both can present as one-sided, chronic pain, and may overlap in patients who experience both headache types. However, nummular headache lacks the full array of migrainous features. While migraine is notorious for symptoms like nausea, photophobia (light sensitivity), and phonophobia (sound sensitivity), nummular headache tends to skip these dramatic accompaniments. Still, misdiagnosis or diagnostic confusion can occur, making a thorough clinical history and sometimes neuroimaging crucial.
When it comes to treatment, the therapeutic script is ever-evolving, as no universal medication is considered first-line due to the rarity of the condition. Nevertheless, options commonly include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, topical pain relievers, or capsaicin ointments. For persistent or severe cases, oral preventive medications such as gabapentin have shown the most evidence among oral options, while onabotulinumtoxinA (Botox) injections have emerged as particularly effective and well-tolerated, sometimes even outperforming oral medications. Other possibilities include nerve blocks, physical therapy, or rarely, anti-CGRP monoclonal antibodies when other treatments fail.
While prescription and OTC medications provide structure, lifestyle edits may help tip the balance between chase and remission. Patients often benefit from stress management strategies (like mindfulness or cognitive-behavioral therapy), keeping a regular sleep schedule, and staying well-hydrated. Avoiding known headache triggers—whether emotional stress, poor posture, or trauma to the scalp—can prevent flare-ups. Gentle exercise and scalp relaxation techniques round out this holistic approach for some.
Certain dietary interventions may also warrant a supporting role. Emerging evidence and case reports suggest that diets such as the ketogenic diet might help some individuals achieve remission, possibly by modulating inflammation or nervous system excitability. Ultimately, while lifestyle and diet tweaks may not replace medical management, they often add that missing spark—empowering patients with nummular headache to claim just a little more comfort, clarity, and control in their daily script.