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Rodriguez-Caravaca, GAuthor

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September 27, 2022
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Clinical and pathophysiological description of nummular headaches: a case series

Publicated to:Revista De Neurologia. 70 (5): 171-178 - 2020-03-01 70(5), DOI: 10.33588/rn.7005.2019152

Authors: Clar-de-Alba, B; Barriga, FJ; Rodríguez-Caravaca, G

Affiliations

Hosp Univ Fdn Alcorcon, Unidad Neurol, Avda Budapest 1, E-28922 Alcorcon, Madrid, Spain - Author
Hosp Univ HM Madrid Monte Principe, Serv Anestesia, Madrid, Spain - Author
Univ Rey Juan Carlos, Escuela Int Doctorado, Madrid, Spain - Author
Univ Rey Juan Carlos, Fac Ciencias Salud, Madrid, Spain - Author

Abstract

Introduction. Nummular headache was initially described as an infrequent primary headache characterised by chronic circumscribed mild-to-moderate pain in a small area of the head that may present with exacerbations. Since its initial description, dozens of cases of nummular headache have been reported which broaden the clinical and pathophysiological spectrum. Aims. To review and establish the clinical characteristics of nummular headache, to analyse the epidemiology in our setting and to clarify some unanswered pathophysiological issues. Patients and methods. The study involved 83 cases (42 women and 41 men) who were diagnosed with nummular headache from July 2008 and followed up until 2018 at the Fundacion Alcorcon Hospital. The mean age of onset was 46 years. The time to diagnosis was seven months. Results. The pain was moderate-intense and oppressive, with exacerbations in 62.5% of cases. The average size of the symptomatic area was 2.4 +/- 0.7 cm, with a parietal (47%), temporal (24%), frontal (12%) or occipital (6%) location. It presented a chronic (82%) or episodic (18%) pattern. Symptoms of local sensory dysfunction were observed in 25 patients and three others showed skin alterations. Spontaneous remission was observed in 36% of cases, and the most commonly used drugs were non-steroidal anti-inflammatory drugs, paracetamol and gabapentin. Botulinum toxin was effective. Conclusions. Nummular headache is a disorder with well-defined characteristics and is considered an entity in its own right. Our data indicate that its origin lies in the epicranial structures. The conjunction of pain, sensory dysfunction and trophic disorders suggests a local form of a complex regional syndrome.

Keywords

AcetaminophenAdultAgedAged, 80 and overAgingAnalgesic agentAnalgesicsAnti-inflammatory agents, non-steroidalArticleBotulinum toxinBotulinum toxinsBupivacaineDelayed diagnosisDisordersEpicraniumEpidemiologyExperienceFeaturesFemaleFollow upFollow-up studiesFrontal lobeGabapentinHeadacheHeadache disorders, primaryHumanHumansIncidenceMajor clinical studyMaleMiddle agedNonsteroid antiinflammatory agentNummularNummular headacheOccipital lobePain intensityPain measurementParacetamolParietal lobePathophysiologyPrimary headacheRemissionRetrospective studiesRetrospective studyReviewSensation disordersSensory dysfunctionSkin diseaseTemporal lobeTherapy effectToxin type-aVery elderlyYoung adult

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Revista De Neurologia, and although the journal is classified in the quartile Q4 (Agencia WoS (JCR)), its regional focus and specialization in Clinical Neurology, give it significant recognition in a specific niche of scientific knowledge at an international level.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.85, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-12, the following number of citations:

  • WoS: 4
  • Scopus: 9

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-12:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 12 (PlumX).

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author () and Last Author (Rodríguez Caravaca, Gil).