title: Bifocal nummular headache: a series of 6 new cases.
abstract: OBJECTIVE
  We aimed to report 6 new cases of bifocal nummular headache (NH), showing their clinical characteristics and comparing them with those formerly described.
  
  
  BACKGROUND
  NH is a focal head pain felt in a small, well-circumscribed, coin-shaped area. Among all the reported cases (over 200), 6 patients localized their pain in 2 or more separate areas.
  
  
  METHODS
  We reviewed all patients diagnosed with NH at the headache clinics of 2 tertiary hospitals, searching for cases with head pain in 2 different areas.
  
  
  RESULTS
  Six patients (4 female, 2 male; age at onset 40.8 ± 19.1, range 24-69 years) presented with bifocal NH. The shape and size of both painful areas were identical in each patient. They were located at symmetrical points of either side in 3 patients, while 2 patients had both symptomatic areas on the same side of the head. The chronological pattern was synchronous in 2 patients, and the other 4 showed an additive pattern with onset intervals between the 2 areas ranging from 2 months to 30 years. Pain intensity was slightly different in each area in 4 of the cases. Four patients were treated with a preventive (gabapentin or carbamazepine) with good clinical response.
  
  
  CONCLUSIONS
  Although not frequently found, some patients may have bifocal or multifocal NH.
authors.affiliation: Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, Valladolid, Spain. gueneurol@gmail.com
authors.forename: Angel L
authors.initials: AL
authors.lastname: Guerrero
authors.forename: María L
authors.initials: ML
authors.lastname: Cuadrado
authors.forename: María E
authors.initials: ME
authors.lastname: García-García
authors.forename: Elisa
authors.initials: E
authors.lastname: Cortijo
authors.forename: Sonia
authors.initials: S
authors.lastname: Herrero-Velázquez
authors.forename: Octavio
authors.initials: O
authors.lastname: Rodríguez
authors.forename: Patricia
authors.initials: P
authors.lastname: Mulero
authors.forename: Jesús
authors.initials: J
authors.lastname: Porta-Etessam
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D055815:Young Adult
chemical_list: D000700:Analgesics