We aim to highlight the potential use of rimegepant, a calcitonin gene-related peptide (CGRP) antagonist as a treatment for nummular headache.

Nummular headache is a rare headache disorder characterized by a coin-sized area of pain most commonly occurring over the temporoparietal region. Non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, tricyclic antidepressants, and onabotulinum toxin A injections have been reported to be effective in small studies. We hereby present a case of nummular headache effectively treated with the CGRP antagonist rimegepant.

This is a 39-year-old female with a history significant for migraine (with or without aura) who presented with intermittent severe headaches localized to a quarter-sized area over the left temple. These headaches were associated with rare photophobia, visual aura, or facial tingling. She tried several abortive headache medications previously including sumatriptan and rizatriptan, which were ineffective and poorly tolerated. She was then started on rimegepant for nummular headache which provided significant and lasting headache relief.

This case highlights the CGRP antagonist medications as potential treatment options for severe or refractory nummular headache.