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Bifocal Nummular Headache: A Series of 6 New Cases

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(Headache 2011;51:1161‐1166)

Objective.— We aimed to report 6 new cases of bifocal nummular headache (NH), showing their clinical characteristics and comparing them with those formerly described.

Background.— NH is a focal head pain felt in a small, well‐circumscribed, coin‐shaped area. Among all the reported cases (over 200), 6 patients localized their pain in 2 or more separate areas.

Methods.— We reviewed all patients diagnosed with NH at the headache clinics of 2 tertiary hospitals, searching for cases with head pain in 2 different areas.

Results.— Six patients (4 female, 2 male; age at onset 40.8 ± 19.1, range 24‐69 years) presented with bifocal NH. The shape and size of both painful areas were identical in each patient. They were located at symmetrical points of either side in 3 patients, while 2 patients had both symptomatic areas on the same side of the head. The chronological pattern was synchronous in 2 patients, and the other 4 showed an additive pattern with onset intervals between the 2 areas ranging from 2 months to 30 years. Pain intensity was slightly different in each area in 4 of the cases. Four patients were treated with a preventive (gabapentin or carbamazepine) with good clinical response.

Conclusion.— Although not frequently found, some patients may have bifocal or multifocal NH.
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Document Type: Research Article

Affiliations: 1: From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam). 2: From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam). 3: From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam). 4: From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam). 5: From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam). 6: From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, E. Cortijo, S. Herrero-Velázquez, and P. Mulero); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, M.E. García-García, O. Rodríguez, and J. Porta-Etessam).

Publication date: July 1, 2011

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