Nummular headaches cause continuous pain in a small, coin-shaped part of the head. Usually, this is a 1 to 6 cm sized area on one side at the temple.

The pain from a nummular headache is called parietal pain. This is because it occurs in a part of the head called the parietal lobe region.

This article explains what causes a nummular headache and what parietal pain feels like. It also discusses how this type of headache is diagnosed and treated.

Nummular Headache Symptoms

Nummular headache pain is usually chronic. This means it happens intermittently in the same spot anywhere on the scalp. The pain does not spread to other places.

Parietal headaches are commonly found on either the right side or left side of the head. They occur in areas called the parietal lobe regions. The spot is a small circle or oval where a parietal headache location will stay fixed. The area ranges in size from about 1 centimeter (roughly the size of a penny) to 6 centimeters (around 2.5 inches).

Parietal Head Pain

A nummular headache will rarely occur on both sides of the head. It also does not affect more than one site on the scalp at the same time. The pain is typically always in the same spot and is often described as a stabbing pain. The pain also might be associated with numbness and tingling at the site.

People with nummular headaches often describe mild to moderate pain, but it can also be severe. The pain is often described as stabbing or pressure-like. 

After the headache stops, some people experience other sensations in the area where they had pain. This might include tingling and numbness. A healthcare provider may be able to reproduce the tenderness when pressing on the area of the head during a physical examination.

Causes of Nummular Headaches

Nummular headaches are considered primary headaches. A parietal headache is not a sign of a stroke or other medical problem. However, cases that were associated with other health conditions have been reported.

Researchers think nummular headaches might be caused by irritation of the trigeminal nerve. The branches of this nerve send sensory signals from the face to the brain.

There could also be a connection between nummular headaches and migraines. In fact, around half of those who have been diagnosed with nummular headache also have a diagnosis of some other type of chronic headache, such as migraine or tension headache.

Nummular Headache and Trigeminal Nerves

The trigeminal nerves run along each side of the face and provide sensation. These cranial nerves have three branches. The ophthalmic nerve feeds the eye and forehead, and the others reach the nose, cheeks, mouth, and jaw. Pain (neuralgia) in the nerve is thought to be a possible cause of a nummular headache and related to nerve compression or irritation.

Some people also start having nummular headaches after a head injury.

Diagnosing Nummular Headache

To diagnose a nummular headache, a healthcare provider will usually order imaging of the brain. These tests may include computed tomography (CT) scan or magnetic resonance imaging (MRI). Nummular headaches are rare, so these tests can help providers rule out other more common causes first.

Differential Diagnosis

Your healthcare provider will carefully look at your scalp to make sure there are no rashes. Sometimes, rashes such as those caused by shingles can mimic nummular headache pain. Other conditions that can mimic nummular headaches include:

  • Bone infections like osteomyelitis
  • Multiple myelomas
  • Paget’s disease
  • Cancer that has spread (metastatic cancer)

Once other conditions have been ruled out, a diagnosis is usually based on specific characteristics of the pain. The location of the pain, its intensity, how long the pain lasts, and how it comes on are some of the things that might make your healthcare provider suspect nummular headache.

Accompanying symptoms such as nausea and vomiting, stuffy nose, or sensitivity to light can help a healthcare provider rule out nummular headache.

Nummular Headache Treatment

Many medications can be used to relieve parietal headache pain. Some of these include:

  • Non-steroidal anti-inflammatories (NSAIDs)Neurontin (gabapentin) Tricyclic antidepressants like Elavil (amitriptyline)

Nerve blocks in the area can also be helpful.

Botox is an option for treating nummular headaches that do not respond to medication. Botulinum toxin is produced by the Clostridium botulinum bacterium. It works by blocking nerve connections on the scalp. It was approved by the Food and Drug Administration (FDA) in 2010 for the treatment of chronic migraine.

Unfortunately, no single therapy has proven effective in substantially reducing the severity and/or frequency of nummular headache symptoms.

Can Nummular Headaches Be Prevented?

You can’t always prevent headaches. This is because some of the factors that contribute to them are not things you have control over. 

For example, some people experience a nummular headache after they get a head injury. There are steps you can take to reduce your risk of these injuries (like wearing a helmet when you ride a bike), but accidents are not always completely avoidable. 

Other possible contributors to nummular headaches like autoimmune disorders can’t always be prevented, either.

If you are prone to any kind of headache, including nummular headaches, talk to your provider about prevention. 

In some cases, certain medications can help keep headaches at bay. Treatments for trigeminal neuralgia seem to help with migraines. They could help prevent nummular headaches as well.

Coping With Nummular Headaches

If you’re living with nummular headaches, it’s important to take care of your overall physical and mental health. Some steps that you can take include:

  • Getting enough quality sleep
  • Finding ways to reduce your stress levels
  • Staying active
  • Eating a balanced and nutritious diet
  • Staying hydrated with water
  • Avoiding substances (e.g., alcohol, caffeine, certain foods) that seem to trigger your headaches
  • Quitting smoking or using substances
  • Taking your medications as prescribed by your provider
  • Asking your healthcare provider before trying supplements, over-the-counter (OTC), or natural remedies for your symptoms
  • Making sure you understand your provider’s recommendations and treatment plan
  • Working with a physical therapist
  • Exploring other treatments like acupuncture and pressure points
  • Staying up to date with preventive care like annual wellness visits, vaccinations, and health screenings
  • Reaching out for support from family and friends, a mental health professional, or a support group

Summary

Nummular headaches may affect just a small place on your head, but they can have a big effect on your daily life. This type of headache is rare and is thought to be related to irritation of certain nerves. Some people with migraines also get nummular headaches, while others develop them after a head injury.

If you’re having headaches, talk to your provider. They can diagnose the type of headache you’re having and recommend the best treatment. It’s also important that you reach out for support as you learn to cope with nummular headaches to ensure you’re taking care of yourself physically and mentally.

A Word From Verywell

Since nummular headaches are rare, you need to see a provider to make sure they are truly the cause of your pain. Your provider will look closely at your scalp and head and use imaging scans to rule out other headache causes.

Once you have been diagnosed with nummular headaches, you can work with your provider to come up with a plan to treat and manage them. Living with headaches that are chronic can be hard, so it’s important that you reach out for support.

Frequently Asked Questions

  • How rare is parietal headache pain?
  • True cases of nummular headaches occur in about six out of every 100,000 people. This can make the diagnosis and treatment challenging, but there are some options you can try.For example, researchers who studied 110 cases of nummular headaches found that successfully treated people were more likely to have received botulinum toxin (botox) and gabapentin.
  • Learn More:
  • Overview of Neurontin (Gabapentin)
  • Is parietal headache pain sharp?
  • Parietal headache pain has been described as severe stabbing or sharp pain. Burning or a “wound-like” pain in the scalp occurs as the headache fluctuates in intensity.
  • Is parietal headache pain a sign of stroke?
  • A parietal headache is not considered to be a symptom of an underlying medical condition like a stroke. Symptoms of some conditions can mimic those of parietal headaches. Severe head pain should be evaluated by a healthcare provider to rule out other serious or life-threatening causes.
  • Learn More:
  • Stroke: Signs, Symptoms and Complications
  • What is a red-flag headache?
  • A red-flag headache can be a sign of a more serious health concern. Signs and symptoms that can be “red flags” for headaches include:A headache that comes on suddenly and is severeHeadaches that are getting more frequent or getting worseHeadaches that start for the first time after the age of 50Other symptoms along with head pain like fever, limb weakness/numbness, or problems seeing, walking, or speakingHeadaches that start during pregnancy
  • Learn More:
  • Headaches During Pregnancy

True cases of nummular headaches occur in about six out of every 100,000 people. This can make the diagnosis and treatment challenging, but there are some options you can try.

Parietal headache pain has been described as severe stabbing or sharp pain. Burning or a “wound-like” pain in the scalp occurs as the headache fluctuates in intensity.

A parietal headache is not considered to be a symptom of an underlying medical condition like a stroke. Symptoms of some conditions can mimic those of parietal headaches. Severe head pain should be evaluated by a healthcare provider to rule out other serious or life-threatening causes.

A red-flag headache can be a sign of a more serious health concern. Signs and symptoms that can be “red flags” for headaches include: