Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review.

[OBJECTIVE] To report 2 new nummular headache (NH) cases and review the clinical features and management of NH.

[BACKGROUND] NH is a coin-shaped headache with a fixed shape and size. Since the first case series was reported by Pareja, approximately 300 cases have been reported. However, the latest treatment status and pathogenesis of NH remain unclear.

[METHODS] Two new NH cases with improved symptomatic responses to metoprolol were reported. We also conducted a narrative review of cases published in English aiming to provide the newest information about the clinical features and management of NH.

[RESULTS] Two NH patients with skin depressions within the painful area experienced significantly improvement with metoprolol. The literature review showed that NH was mainly moderate-to-severe in 77.8% (186/239) of the patients. Sensory dysfunction and focal trophic changes were reported in 47.8% (149/312) and 3.8% (12/312) of the patients, respectively. Gabapentin was the most commonly used and effective prophylactic, with a responder rate of 67.9% (55/81). Botulinum toxin type A was used for refractory NH, with an effective rate of 81.8% (9/11). Ten patients from the previous studies were prescribed β-adrenergic blockers without any relief, and none of them reported focal tropic changes.

[CONCLUSIONS] NH can be a disabling headache in more than half of identified patients and requires medical intervention. As with the previous treatment recommendations, gabapentin was the most commonly used prophylactic with a good response. Our cases suggested that β-adrenergic blockers could be a therapeutic option for NH patients with focal trophic changes within the areas.