Pressure pain sensitivity map of multifocal nummular headache: a case report.
BACKGROUND
Nummular headache (NH) is most commonly a localized unifocal headache; however, some patients infrequently exhibit multifocal symptomatic painful head areas retaining all features of NH. We present the pressure pain sensitivity map of an adolescent with multifocal NH.


METHODS
We describe a case of a 14 year-old-girl with a 3-year history of continuous pain in four rounded areas, all of them with the same size and shape. Pressure pain thresholds (PPT) were assessed on 21 points over the scalp and over the symptomatic areas. A pressure pain sensitivity map of the head was constructed. The neurological exam was unremarkable, with neither sensory symptoms nor trophic changes within the painful areas. As previously shown, symptomatic points exhibited lower PPTs compared to the surrounding areas. The map reflected 4 restricted areas of mechanical hyperalgesia confined just to the painful areas. Treatment with gabapentin achieved complete remission.


CONCLUSIONS
This is the first pain sensitivity map of a patient with multifocal NH. Our results support peripheral mechanisms are maintained in multifocal NH.
Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain, crispav@hotmail.com.
Cristina
C
Rodríguez
Sonia
S
Herrero-Velázquez
Marina
M
Ruiz
Johanna
J
Barón
Alicia
A
Carreres
Edert
E
Rodríguez-Valencia
Angel Luis
AL
Guerrero
Pascal
P
Madeleine
María Luz
ML
Cuadrado
César
C
Fernández-de-Las-Peñas
D000293:Adolescent; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005260:Female; D000077206:Gabapentin; D006261:Headache / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D009460:Neurologic Examination; D017288:Pain Threshold / Q000502:physiology; D011312:Pressure; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin