Trifocal Nummular Headache: A Case Report of Dramatic Response to Local Anesthetic Injection

The nummular headache is characterized by focal pain in an oval or elliptic region of the head, typically 1-6 cm in diameter. Pain localization is commonly monofocal, but occasionally it is bifocal or multifocal, with each symptomatic region exhibiting all characteristics of nummular pain. It was first described by Pareja and included in the 3rd edition of the International Classification of Headache Disorders (ICHD-3) under primary headache. We report a case of a 51-year-old male patient with nummular headache presenting in three areas on the scalp, which is rarely observed. Local anesthetic was injected onto the sphenopalatine ganglion, resulting in immediate recovery. Nummular headache is a rare but sometimes very severe pain, and lidocaine is an effective treatment option.