Abstract Details

Title Nummular Headache in Children: A Case Series and Systematic Literature Review

Topic Headache

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-001

Objective To report 6 new cases of children with Nummular Headache (NH) and review existing pediatric cases from the literature.

Background NH is a rare primary headache disorder characterized by continuous or intermittent pain localized to a fixed, sharply-contoured, round or elliptical area 1-6 cm in diameter.¹ NH can be disabling and refractory to treatment. Over 300 cases have been reported,^2-4 but only 9 in the pediatric population.^{2, 5-12}

Design/Methods Retrospective database query and chart review of children diagnosed with NH at the Cincinnati Children’s Headache Center from 2002-2021. A PubMed search was also performed for “nummular headache” OR “coin shaped headache” OR “coin shaped cephalalgia” and evaluation of select articles form the reference lists of substantial reviews. All English-language publications describing NH in children were included. Age at onset, sex, location(s), quality, severity, timing, local trophic changes, comorbid headache disorders, management and clinical course were extracted.

Results 6 children were identified from our institution. 9 children with NH were identified from 107 unique publications. Median age at onset was 12 years with female:male ratio of 2:1. Location was midline (4), bilateral (3), right (3) or left (2) with allodynia reported in 5. Quality varied greatly and frequency ranged from every other week to continuous. Imaging was normal except in two published cases and two new cases with mega-cisterna magna and small pineal cyst. Migraine was comorbid in 7 cases and hypermobility was present in 2 of our 6 cases. Published cases were refractory to indomethacin, steroid and lidocaine injections, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). 4 of our cohort improved with therapy for comorbid migraine, one was lost to follow-up and another only recently diagnosed. Onabotulinumtoxin A was ineffective in both of our attempted cases.

Conclusions NH is rarely reported in children. We describe characteristics of 6 new and 9 previously published cases.

Authors/Disclosures
Daniel Lax, MD (Montefiore Medical Center) PRESENTER	Dr. Lax has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Lax has received personal compensation in the range of $500-$4,999 for serving as a CME Lecturer with American Headache Society.
Marielle K. Samaha, MD, FAHS, FAAN, FAAN (Cincinnati Children's Hosp Medl Ctr)	Dr. Samaha has received personal compensation in the range of $500-$4,999 for serving as a Consultant for theranica. Dr. Samaha has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for AAN . The institution of Dr. Samaha has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for AAP. Dr. Samaha has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for theranica.
Joanne Kacperski, MD (Cincinnati Children's Hospital)	Dr. Kacperski has nothing to disclose.
Andrew D. Hershey, MD, PhD, FAAN, FAHS, FAAN	The institution of Dr. Hershey has received personal compensation in the range of $0-$499 for serving as a Consultant for Amgen. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernus. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Upsher-Smith. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. The institution of Dr. Hershey has received research support from Amgen. The institution of Dr. Hershey has received research support from NIH, NINDS. The institution of Dr. Hershey has received research support from Bioahaven. The institution of Dr. Hershey has received research support from Upsher-Smith. Dr. Hershey has received publishing royalties from a publication relating to health care.

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