Nummular headache: a coin-sized pain with nothing underneath it but a sensitized nerve map.

One small round patch of scalp that aches, stings, or feels tender for months, and a scan that shows nothing. Rare, real, and worth understanding.

This page is about understanding the condition and the role the brain and nervous system can play in it. It is not a diagnosis. Your own clinicians know your case.

What nummular headache is

Nummular comes from the Latin for coin, and the name describes the condition exactly. The pain sits in one fixed, well-defined, round or elliptical area of the scalp, typically the size of a large coin, 2 to 6 cm in diameter. The area does not change over time. The pain is usually mild to moderate and pressure-like or aching, either continuous or coming and going, and many people report sharp, brief stabs superimposed on it that may lengthen from seconds to minutes or hours. The patch is often tender, with altered sensation such as numbness, tingling or heightened sensitivity to touch.

Just as important is what nummular headache lacks. There is no nausea or vomiting, no sensitivity to light or sound, no runny nose, tearing or red eye, and no other neurological symptoms. Physical examination of the scalp and skull is normal. Imaging is normal; it is done to exclude a lesion in the bone or beneath it, and once that is excluded, the diagnosis rests on the pattern.

The neuroplastic contribution

Neuroplastic symptoms are real symptoms generated by learned pathways in the brain and nervous system rather than by ongoing damage or disease in the body. Pain is an alarm the brain produces to protect you, and the brain holds a detailed map of the body's surface. A small region of that map can become sensitized so that the brain produces pain, tenderness and strange sensations in one precise spot, with nothing wrong in the skin or bone. The pain is real. It is not imaginary and it is not 'all in your head' in any dismissive sense. And because the brain is plastic, the map can be reset.

The ATNS Index of Neuroplastic Symptoms says that for nummular headache, neuroplastic symptoms should be assessed as part of a complete evaluation.

Why a coin-shaped pain fits a sensitized nervous system:

• A sharply bordered area that never moves looks like a region in the brain's body map, not a pattern of injured tissue.
• Tenderness, tingling and altered sensation within the patch are the signature of sensitized nerves.

Our guide to central sensitization explains the mechanism in more detail.

What the research shows

Nummular headache is rare, and the research is mostly case series rather than controlled trials. A systematic review and analysis of 110 published cases found a median age at onset of 42, a median of three attacks a day, and a median delay of 18 months from first attack to correct diagnosis, which reflects how often the condition is missed. Gabapentin, anti-inflammatories, botulinum toxin injections and tricyclic antidepressants were the most used and most effective treatments, and younger age and earlier diagnosis were associated with complete resolution.

A 2025 systematic review and meta-analysis pooled the observational studies on the epidemiology and clinical features of nummular headache, confirming the typical picture: a fixed coin-sized patch, usually parietal, with sensory changes in the area and normal examination. A 2026 systematic review of treatment outcomes across 37 mostly case-based studies and 1,012 patients found no standardised guidelines and low-quality evidence overall, with botulinum toxin the most thoroughly studied option: complete remission in roughly half of treated patients and a meaningful response in two thirds or more.

No study has yet measured central sensitization or tested symptom reprocessing in nummular headache, so the neuroplastic framing is an inference from the condition's defining features and from what is known about sensitized pain elsewhere. That the condition can remit spontaneously, and that treatments acting on nerve excitability help, is at least consistent with a nervous-system origin.

Signs the brain may be part of the picture

• Scans and examination of the scalp and skull are normal.
• The patch is tender, tingly or oddly sensitive, but there is no visible change in the skin.
• Pain rises and falls with stress, fatigue or how much attention you give it.
• You touch or press the spot many times a day to check it.

A solution that addresses it

Pain and symptom reprocessing is an approach built for pain the nervous system has learned to produce. It combines education about neuroplastic pain, somatic tracking (attending to the patch with curiosity rather than dread), reducing fear and the sense of threat, a graded return to the activities you have been avoiding such as wearing hats, brushing hair or lying on that side, emotional awareness and expression, and acceptance and commitment skills. Our guide to mindfulness and somatic practices introduces the core skills. Trained clinicians deliver it, and digital programs are making it more accessible. It can run alongside any medication your neurologist prescribes.

Cindra is a daily AI companion built around these approaches, with daily check-ins, short practices and plain-language lessons for people whose symptoms have a neuroplastic component. If a coin-sized patch of pain has outstayed its welcome, you can join the waitlist.

What to do next

1. Get the diagnosis confirmed. A neurologist should examine the scalp and skull and will usually arrange imaging to exclude a lesion in the bone or beneath it. A new, rapidly growing lump, a headache that is the worst of your life, fever, or any weakness, confusion or vision change need prompt medical attention.
2. Discuss treatment options. Nerve-stabilising medication or botulinum toxin injections help many people, and your neurologist can advise.
3. Ask about the neuroplastic assessment. The ATNS index says it belongs in a complete evaluation. Bring the signs above.
4. Start retraining. Reduce checking, learn that the spot is safe, and reintroduce the things you have been avoiding. Our guide to hurt versus harm is a good start.

This article is for general education and is not medical advice, and it does not diagnose or treat any condition. Persistent symptoms deserve a proper medical assessment to rule out disease or injury before a neuroplastic explanation is considered. If your symptoms are new, changing, or come with red-flag signs such as fever, unexplained weight loss, numbness or weakness, chest pain, or loss of bladder or bowel control, see a clinician promptly.