Treatment outcomes in primary nummular headache: a systematic review
Abstract
Background: Nummular headache is a rare primary headache disorder characterized by pain strictly confined to a small, coin-shaped area of the scalp. In the absence of standardized treatment guidelines, management relies on heterogeneous, low-level evidence.
Objectives: To systematically synthesize the available evidence on treatment outcomes in primary nummular headache, focusing on complete remission, clinically meaningful response (≥50% improvement), and treatment tolerability.
Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420261375695). Five electronic databases were searched from inception to March 2026 for studies including ≥5 patients with primary nummular headache according to ICHD criteria. The primary outcome was complete remission; secondary outcomes included ≥50% clinical response and discontinuation due to adverse events. A descriptive synthesis was performed because of substantial clinical and methodological heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale and Joanna Briggs Institute checklists.
Results: Thirty-seven studies (1,012 patients) were included, predominantly case reports, case series, and uncontrolled observational cohorts. OnabotulinumtoxinA was the most robustly evaluated intervention, achieving complete remission in 47.5%-48.8% and ≥50% response in 62.5%-77.4% of patients, with no reported treatment discontinuations due to adverse events. Gabapentin showed complete remission…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,012 participants or records.
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