Treatment of dopplerable nummular headache with minimally invasive arterectomy under local anesthesia

Objective: The objective of the current study is to elucidate the potential role of surgery in the treatment of nummular headache (NH). Background: NH is a disorder in which pain is localized to a specific area. Treatment has traditionally been medical, with the recent addition of nerve blocks and botox injection with equivocal results. Design: Forty-nine patients were identified using the International Classification of Headache Disorders, third edition, beta version. Patients were asked to identify the area of maximal pain. Patients who had an associated Doppler signal within the area of pain underwent surgical arterectomy using local anesthesia. Preoperative and postoperative headache frequency, severity, duration, and headache-free days were analyzed. Results: There were a total of 49 patients included in the study (42F:7M) with an average age of 45 years (21-65 years). The average follow-up period was 16 months with a range of 8-33 months. There was a significant reduction in the frequency (-10.7 days; p < 0.001), severity (-3.5; p < 0.001), and duration (-0.3 hours; p = 0.4) of the headache. There was a significant increase in the number of headache-free days per month (10 vs. 21; p < 0.001). Headache index decreased by 39.6%, from an average of 378.6 to 228.4 (p < 0.05). Twelve patients (24.5%) were free from NH and able to discontinue their medications. There were no complications identified during the follow-up period. Conclusion: NH, although rare, can be associated with significant disability despite current treatment modalities. In select patients, surgical arterectomy is a safe, minimally invasive, and effective treatment for NH. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.