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Nummular headache after trans-sphenoidal surgery: a referred pain-based headache syndrome
- Faculty of Clinical Forensic Medicine, Department of Pathology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung
- department of neurosurgery
- Graduate Institute of Technology and Law, National First University of Science and Technology, Kaohsiung
- 1 Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
open access
Abstract
Nummular headache (NH) is a newly categorized primary headache characterized by a consistent location, shape and size of painful area in each attack. The etiopathogenesis is entirely unknown. Currently, the peripheral theory of epicranial neuralgia is accepted more widely than the central theory but it cannot fully explain the clinical picture.
We report a patient who suffered from a relapsing and remitting course of NH at the high parietal area and vertex shortly after resection for pituitary prolactinoma via a trans-sphenoidal approach. There was no focal trophic change or paresthesia but a mild allodynia in the painful area. The patient did not exhibit trigeminal sensory disorder or cranial trauma thoroughly. The pain responded well to gabapentin. Therefore, physicians should be aware of postoperative NH, which is amenable to treatment. The findings in our patient support a dual mechanism of NH and suggest that central NH is a form of referred pain.
Abstract
Nummular headache (NH) is a newly categorized primary headache characterized by a consistent location, shape and size of painful area in each attack. The etiopathogenesis is entirely unknown. Currently, the peripheral theory of epicranial neuralgia is accepted more widely than the central theory but it cannot fully explain the clinical picture.
We report a patient who suffered from a relapsing and remitting course of NH at the high parietal area and vertex shortly after resection for pituitary prolactinoma via a trans-sphenoidal approach. There was no focal trophic change or paresthesia but a mild allodynia in the painful area. The patient did not exhibit trigeminal sensory disorder or cranial trauma thoroughly. The pain responded well to gabapentin. Therefore, physicians should be aware of postoperative NH, which is amenable to treatment. The findings in our patient support a dual mechanism of NH and suggest that central NH is a form of referred pain.
Keywords
nummular headache, postoperative headache, prolactinoma, trans-sphenoidal surgery
Title
Nummular headache after trans-sphenoidal surgery: a referred pain-based headache syndrome
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
398-401
Page views
443
Article views/downloads
524
DOI
10.5114/ninp.2013.36764
Bibliographic record
Neurol Neurochir Pol 2013;47(4):398-401.
Keywords
nummular headache
postoperative headache
prolactinoma
trans-sphenoidal surgery
Authors
Hsin-Ling Yin
Chi Chui
Wai-Fai Tung
Wei-Hsi Chen