Nummular headache, trochleitis,supraorbital neuralgia, and other epicranial headaches andneuralgias: the epicranias

摘要

Nummular headache is characterized by mild to moderate,pressure-like head pain exclusively in a small, rounded or ovalarea without underlying structural lesions. Either duringsymptomatic periods or interictally, the affected area shows avariable combination of hypoesthesia, dysesthesia, paresthesia,tenderness or discomfort. The particular topography and signs ofsensory dysfunction suggest that nummular headache is anextracranial headache probably stemming from epicranial tissuessuch as the terminal branches of sensory nerves. Apart fromnummular headache, other headaches and neuralgias such asidiopathic stabbing headache, trochleitis, supraorbitalneuralgia, external compression headache, nasociliary neuralgia,occipital neuralgias, and auriculotemporal neuralgia havetemporal or spatial features that suggest a peripheral(extracranial) origin, i. e. stemming from the bone, scalp, orpericranial nerves. Common to these disorders is a focallocalization or a multidirectional sequence of paroxysms,paucity of accompaniments, tenderness on the emergence or courseof a pericranial nerve or on the tissues where pain originates,and possible presence of symptoms and signs (including effectivetreatment with locally injected anesthetics or corticosteroids)of nerve dysfunction. These observations led to the emergence ofa conceptual model of head pain with an epicranial origin thatwe propose to group under the appellation of epicranias(headaches and pericranial neuralgias stemming from epicranialtissues). Nummular headache is the paradigm of epicranias.Epicranias essentially differ from other primary headaches withan intracranial origin and features of visceral pain, i. e.splanchnocranias that are characterized by a painful area widerthan that of epicranias, no clear borders, presence of autonomicfeatures, regional muscle tension, and driving of the processfrom the brain and brainstem.