Epicranial headache: a clinical case series of nummular headache
Abstract
Nummular headache (NH) is a relatively recently characterized clinical entity of a headache that remains a subject of ongoing investigation.
Classified as an epicranial headache, NH involves the terminal branches of the sensory nerves innervating the scalp, pointing toward a
peripheral etiopathogenesis. Although diagnostic criteria are precisely defined, typically involving a circumscribed painful area 2–6 cm
in diameter, frequently accompanied by local sensory disturbances, NH commonly acts as a diagnostic "chameleon". It requires rigorous
differentiation from migraine, trigeminal autonomic cephalalgias, and other headache types with overlapping symptomatology.
We present three case studies of idiopathic NH. In two cases, the headache onset followed an infectious disease, while the third patient had
a history of migraine that had remained dormant for the previous four years. One patient exhibited a chronic clinical course. Notably, two of
the three patients presented with comorbid myogenic temporomandibular disorder. All patients demonstrated a robust therapeutic response
to indomethacin, a medication of proven efficacy in specific primary headache subtypes.
Keywords: nummular headache, coin-shaped cephalalgia, epicranial headache, circumscribed cephalalgia, non-migraine headache.
For citation: Alekseevich G.V., Alekseevich G.Yu. Epicranial headache: a clinical case series of nummular headache. RMJ. 2026;4:18–22. DOI:
10.32364/2225-2282-2026-4-4
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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