🧠 Overview
Nummular headaches are characterized by pain in a very specific, coin-sized area on the top of the head. The pain is caused by compression of small terminal nerve branches that supply sensation to the vertex (top) of the scalp.
🎯 Affected Nerve:
Epicranial sensory fibers (terminal branches of the trigeminal and occipital nerves)
Releasing the nerve at the top of the head
💭 Headache Characteristics
📍 Pain Location
Pain is localized to a circular area on the top of the head, typically 2-6 cm in diameter. Patients can point to the exact spot with one finger. The area is usually off to one side of the midline.
⚡ Pain Character
Described as a sharp, burning, or tender spot on the scalp. The area is extremely sensitive to touch, making it uncomfortable to comb hair, wear hats, or rest the head on a pillow.
🌊 Pain Migration Pattern
Unlike other migraines, nummular headaches typically do NOT spread. The pain remains localized to the coin-shaped area. However, prolonged episodes may trigger secondary tension-type headaches that radiate outward.
✨ Pain Quality
Continuous or near-continuous pain with a burning, stabbing, or tender quality. The affected spot may feel different even to light touch, patients describe it as hyperesthetic (overly sensitive).
🔬 How we confirm it: the numbing test
We place a small injection of local anaesthetic directly into the tender spot. If the pain disappears within minutes, we have found the nerve. Occasionally we repeat the injection a few millimetres away to find the exact spot.
💡 Important: We never recommend surgery without this test, your trust matters too much. If the numbing injection relieves your pain, surgery is very likely to help you. If it does not, we will tell you honestly and keep looking for answers with you.
⚕️ What the operation involves
Through a very small incision (1-2 cm) hidden in the hair, directly over the painful spot, Dr. Sarhane frees the irritated nerve endings from the scar tissue or tight bands around them. It is the quickest of all the procedures, about 20-30 minutes, under local anaesthesia if you wish, and you go home the same day. Nothing goes inside the skull.
📊 What you can realistically expect
💊 Pain relief
Around 85-90% of patients find the pain at that spot goes away completely or almost completely. Most can stop the medicines they were taking for it.
💊 Fewer medicines
Most patients can discontinue all medications specifically used for this headache. Some may continue medications for other headache types if multiple trigger zones are involved.
🏥 Getting back to your life
Back to all normal activities within 3-5 days. The spot may feel a little tender for 1-2 weeks. The tiny incision is hidden in the hair.
⏱️ What the first weeks usually look like:
- First few days: rest at home, simple painkillers if needed. Most people describe soreness rather than pain.
- First week: light activities and desk work for most trigger zones.
- Weeks 2-4: gradually back to exercise and your normal routine.
- Months 1-6: the nerve settles and your migraines improve step by step. Our nursing team stays in touch with you throughout, you are never on your own.