Hello, my name is Mattias McAndrew, and I’m the Head Clinician at Brisbane Headache and Migraine Clinic.
Nummular headache (NH) is a relatively rare, localised headache condition characterised by a consistent, coin-shaped area of pain on the scalp.
It affects a small proportion of headache sufferers but can significantly impact quality of life if misdiagnosed or improperly managed.
This blog explores NH, potential treatments, and how the Watson Headache® Approach can help manage this unique condition.
What is Nummular Headache?
Nummular headache is defined as a localised pain that is round or elliptical, fixed in size and shape, and confined to the scalp.
Diagnosing NH requires ruling out other potential causes, such as neuralgia or structural abnormalities, often using imaging techniques like MRI or CT scans. Most cases are idiopathic, though some secondary causes, such as trauma or underlying neurological issues, have been documented.
According to studies, NH is more common in middle-aged individuals, with a higher prevalence in women.
Symptoms can range from mild to debilitating pain, often described as a steady ache or pressure. In some cases, localised hypersensitivity or allodynia is reported, complicating daily activities such as combing hair or wearing headgear (Grimaldi, D., et al. 2020, Ruiz-López, M., et al. 2020).
Challenges and Current Treatments
The cause of NH remains unclear, but superficial sensory fibre dysfunction or localised inflammation has been suggested.
Treatment often involves medications such as NSAIDs, corticosteroids, or nerve blocks. However, these may provide incomplete relief, and some patients benefit from physiotherapy to address underlying musculoskeletal contributions (Grimaldi, D., et al. 2020, Ruiz-López, M., et al. 2020).
A systematic review highlighted that while pharmacological interventions can be helpful, they often fail to address the mechanical and functional issues contributing to NH symptoms (Grimaldi, D., et al. 2020).
How the Watson Headache® Approach Can Help
At the Brisbane Headache and Migraine Clinic, we employ the Watson Headache® Approach, a hands-on technique that targets the cervical spine’s contribution to headache disorders. While NH originates in the scalp, it may have mechanical triggers from cervical dysfunctions.
The Watson Headache® Approach involves:
- Assessment and correction of cervical joint mechanics to reduce neural sensitisation that may exacerbate headache symptoms.
- Retraining the neural pathways to desensitise the input and output from the brain, which often leads to the pain signal.
- Education and tailored exercise programs to promote long-term spinal health and minimise recurrent episodes.
This comprehensive approach ensures that NH is managed holistically, addressing both local and systemic factors contributing to pain.
Taking Action
If you experience Nummular Headaches, consider a personalised physiotherapy consultation. Working with a clinic specialising in the Watson Headache® Approach can help you understand the connections between your neck, brainstem, and vestibular system.
Taking the first step towards assessment and targeted treatment can lead to significant improvements in both symptoms and quality of life.
For more information or to book an appointment, visit Brisbane Headache and Migraine Clinic’s website. We’re here to help guide you on a path towards relief from vestibular migraine.
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References
Grimaldi, D., et al. (2020). Characteristics and treatment effectiveness of nummular headache: a systematic review and analysis of 110 cases. BMJ Neurology Open.
Ruiz-López, M., et al. (2020). Secondary nummular headache: A case series and review. Pain Medicine.
