• Angel L Guerrero, María L Cuadrado, María E García-García, Elisa Cortijo, Sonia Herrero-Velázquez, Octavio Rodríguez, Patricia Mulero, and Jesús Porta-Etessam.
• Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, Valladolid, Spain. gueneurol@gmail.com
• Headache. 2011 Jul 1; 51 (7): 1161-6.

ObjectiveWe aimed to report 6 new cases of bifocal nummular headache (NH), showing their clinical characteristics and comparing them with those formerly described.BackgroundNH is a focal head pain felt in a small, well-circumscribed, coin-shaped area. Among all the reported cases (over 200), 6 patients localized their pain in 2 or more separate areas.MethodsWe reviewed all patients diagnosed with NH at the headache clinics of 2 tertiary hospitals, searching for cases with head pain in 2 different areas.ResultsSix patients (4 female, 2 male; age at onset 40.8 ± 19.1, range 24-69 years) presented with bifocal NH. The shape and size of both painful areas were identical in each patient. They were located at symmetrical points of either side in 3 patients, while 2 patients had both symptomatic areas on the same side of the head. The chronological pattern was synchronous in 2 patients, and the other 4 showed an additive pattern with onset intervals between the 2 areas ranging from 2 months to 30 years. Pain intensity was slightly different in each area in 4 of the cases. Four patients were treated with a preventive (gabapentin or carbamazepine) with good clinical response.ConclusionAlthough not frequently found, some patients may have bifocal or multifocal NH.© 2011 American Headache Society.

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