Nummular means coin-shaped (think numismatist-coin collector). These are rare and often difficult to treat. Patients complain of a constant, severe pain, without migraine features, localized to a specific area of the scalp, about the size of a silver dollar. Nothing abnormal can be felt in the scalp and it is not tender. MRI is normal. Perhaps some unrecognized injury to scalp sensory nerves is the cause. Medications are usually ineffective. Injecting local anesthetics, e.g. Marcaine, or BOTOX may help.
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