RT info:eu-repo/semantics/doctoralThesis
T1 Caracterización clínica y terapéutica de la cefalea numular en una serie de pacientes
A1 García Iglesias, Cristina
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Neurología
K1 nummular headache
K1 cefalea numular
K1 32 Ciencias Médicas
AB BackgroundNummular headache (NH) was first described in 2002 by Juan Pareja, who identified a circumscribed coin-shaped type of pain in the head. In 2005, NH was included in the International Classification of Headache Disorders in its research appendix and in 2018 in the main body of the classification. Its pathophysiology suggests an epicranial origin related to superficial nerve fibers. More than 500 cases have been reported worldwide, which has allowed us to better define its clinical phenotype and response to treatment. It usually affects middle-aged adults, with a female predominance and parietal location. The diagnosis is clinical and is supported by neuroimaging studies to rule out other causes. Its treatment still lacks clinical trials, although several drugs have been used with variable results.ObjectivesThe objectives of this thesis are: 1) Describe a series of cases of secondary nummular headache; 2) Analyze, in an extensive hospital series of patients with NH: the effectiveness and tolerance of symptomatic and preventive treatment, compare the different preventive treatments, and establish, based on this, a series of therapeutic recommendations; 3) Analyze, in the follow-up of an extensive hospital series of patients with NH: the natural history of patients who do not require preventive treatment and the evolution of patients who receive preventive treatment.MethodsTo achieve the objectives of the thesis, three observational studies were carried out in a tertiary public hospital, based on a prospective registry started in 2008. The studies included: a series of cases of secondary NH, the NUMITOR study, which evaluated the response to symptomatic and preventive treatments in 183 patients, and a longitudinal study with 168 patients and a mean follow-up of 6.7 years. Each study had its specific inclusion criteria. Demographic variables, clinical phenotype, response to treatments and long-term evolution were analyzed. Data were collected through medical records and personal interviews, and stored in the REDCAP database. Statistical tests were used to evaluate associations and the effectiveness of the treatments, with a significance threshold of 0.05.ResultsThe thesis included the publication of three articles on NH. In the first study, 8 cases of secondary NH associated with structural lesions were identified, classified as intracranial, bone and subcutaneous, and the cases of secondary NH published in the literature were reviewed, observing the similarity of the phenotypic and demographic characteristics of the primary and secondary cases. The second study (NUMITOR) analyzed the response to treatment in 183 patients, demonstrating that onabotulinumtoxinA (onabotA) was the most effective and best tolerated preventive treatment, followed by gabapentin. In the third study, with a mean follow-up of 6.7 years in 168 patients with NH, it was observed that two-thirds of the patients required preventive treatment, with a favorable response in 80% of the cases, and a group of patients presented spontaneous remission throughout the follow-up.ConclusionsThe clinical and demographic characteristics of secondary and primary NH are similar. It is recommended to perform neuroimaging studies systematically. In many cases, the response to medical treatment prevented surgery, highlighting OnabotA as an effective preventive option. In the NUMITOR study, OnabotA was the most effective and best tolerated preventive treatment. In long-term follow-up, after a median of 6.7 years, the majority of patients were symptom-free and those who remained symptomatic showed a reduction in headache frequency. Two-thirds of patients required preventive treatment and 80% responded favorably, and almost half experienced complete freedom from pain at the end of follow-up.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/76134
UL https://uvadoc.uva.es/handle/10324/76134
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 18-jul-2025