García-Azorín, D. (David)

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    Treatment of primary nummular headache: a series of 183 patients from the NUMITOR study
    (2023) García-Iglesias, C. (Cristina); Valle-Peñacoba, G. (Gonzálo); Guerrero-Peral, A.L. (Ángel Luis); Irimia, P. (Pablo); Puledda, F. (Francesca); García-Azorín, D. (David); Sierra-Mencia, A. (Álvaro); González-Celestino, A. (Ana); Echavarria-Iñiguez, A. (Ana); Recio-García, A. (Andrea); González-Osorio, Y. (Yesica)
    Nummular headache (NH) is a primary headache characterized by superficial coin-shaped pain. NUMITOR (NCT 05475769) is an observational study evaluating the responder rate of preventive drugs in NH patients. The treatment response was assessed between weeks 8 and 12 compared with the baseline. Patients were included between February 2002 and October 2022. Demographic and clinical variables were assessed; treatment response was estimated by 50%, 30%, and 75% responder rates and treatment discontinuation due to inadequate tolerability. A total of 183 out of 282 patients fulfilled eligibility criteria and completed the study. Patients were aged 49.5 (standard deviation (SD): 16.8) years, and 60.7% were female. NH phenotype was a parietal circular pain of four centimeters' diameter, moderate intensity, and oppressive quality. At baseline, patients had 25 (interquartile range) pain days per month. Preventive treatment was used by 114 (62.3%) patients. The highest 50% and 75% responder rates corresponded to onabotulinumtoxinA (62.5%, 47.5%), followed by gabapentin (43.7%, 35.2%). Oral preventive drugs were not tolerated by 12.9-25%. The present study provides class IV evidence of the effectiveness of oral preventive drugs and onabotulinumtoxinA in the treatment of primary NH. OnabotulinumtoxinA was the most effective and best-tolerated drug, positioning it as first-line treatment of NH.