What Is Nummular (Coin-Shaped) Headache? Symptoms, Diagnosis, and Treatment Options
Medically reviewed by: Christina Duffy-Henriques, RN, MSN, APRN, AGPCNP-BC, AQH
What is Nummular Headache?
Nummular headache is a rare headache disorder. It got its name because the pain occurs in a small, round or oval area on the scalp, often about the size of a coin.1 (Nummular means ‘resembling a coin’.) The pain stays within a fixed area, typically 1 to 6 centimeters wide.1 Some people call it a coin-shaped headache.1 Because it is not caused by any underlying condition, it is classified as a rare, chronic primary headache disorder.1
What Are Symptoms of Nummular Headache?
People can pinpoint the exact location of their headache. It commonly affects the top or sides of the scalp in the parietal region, but can occur anywhere on the scalp. The right side is more commonly affected than the left or center regions.2 Pain is often described as steady, pressing, sharp, stabbing, burning, or pulsating/throbbing.2 The affected area may feel numb, tingly, sensitive, tender, burning, or even painful to light touch.2 Some people have pain in more than one location during an attack.3 (This is known as bifocal or multifocal nummular headache.)
Most people have mild to moderate pain, but for some, it can be severe. Nummular headache is often chronic (more than 15 days per month), but it can come and go.
Who Gets Nummular Headache?
Nummular headache was first documented in 2002.4
From what we do know, women are more likely to have nummular headache than men by about 50%.4 It can develop at any age, but it’s most common in people in their 40s.3
Almost half of those living with nummular headache have a current or past history of another headache disorder, such as migraine, medication overuse, ice pick, or tension-type headache.2 Nummular headache can also develop after trauma.5
Nummular headache can also occur in children, but it is extremely rare. Only six children have been described in published studies.6 More research is needed to better understand nummular headache in children.
What Treatments Can Help Manage Nummular Headache?
Clinicians recommend both acute and preventive treatment for nummular headache. However, there are limited studies on the best ways to treat this condition. The most common treatments include gabapentin and onabotulinumtoxinA (Botox).
Some other treatment options include:3,4,7
- Pain relievers and NSAIDS, such as acetaminophen and ibuprofen
- Tricyclic antidepressants such as amitriptyline and nortriptyline
- Indomethacin
- Carbamazepine
- Pregabalin
- Topiramate
- Cyclobenzaprine
- Neurotropin
- Palmitoylethanolamide
- Transcutaneous nerve stimulation (TENS)
Over 40% of people experience complete remission of their nummular headache, with or without medication.3
Ruling Out Other Conditions
Since nummular headache is rare, other possible causes are usually ruled out first.4 A healthcare provider may examine your scalp to check for a shingles rash. Or, if the pain is located in the temporal area, blood tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein, are typically ordered to rule out a condition called temporal arteritis. Sometimes, a healthcare provider may recommend additional blood tests or imaging, such as a CT scan or MRI. They may also evaluate for other conditions, including autoimmune disorders, tumors, lesions, vascular issues, infections, and temporomandibular disorders.4
Getting Help
While nummular headache is very rare, it can be very painful and affect a person’s quality of life. Research on this condition is limited, but a clinician who specializes in headache medicine can help with diagnosis and treatment.
References
- https://ichd-3.org/other-primary-headache-disorders/4-8-nummular-headache/
- https://doi.org/10.1007/s11910-019-0943-x
- https://karger.com/ned/article/doi/10.1159/000547805/933940/Epidemiology-and-Clinical-Characteristics-of
- https://www.ncbi.nlm.nih.gov/books/NBK540991/
- https://pubmed.ncbi.nlm.nih.gov/30961529/
- https://link.springer.com/article/10.1007/s10072-025-08494-z
- https://pubmed.ncbi.nlm.nih.gov/36614923/
Author
Molly O’Brien is a journalist originally from the Seattle area. She graduated summa cum laude from Arizona State University with a degree in Broadcast Journalism and went on to work on-air reporting in local news markets across the country.
Molly was diagnosed with episodic migraine around the age of four, which progressed to chronic migraine in her mid-twenties. Migraine continues to affect her daily life as she manages her health alongside her career and family responsibilities.
She serves as the Media and Public Relations Manager at the Association of Migraine Disorders, and is the producer and host of the Migraine Minute News Update and the Spotlight on Migraine podcast.
