4.8 Nummular headache

Identification: A 32-year-old female patient, a teacher, presents to the consultation with a complaint of localized scalp pain for 6 months.

History of Present Illness: The patient reports pain in a well-circumscribed, round area, approximately 3 cm in diameter, in the left parietal region. She describes the pain as moderate, continuous, with periods of exacerbation, of a "burning" or "pressure" type. The pain does not radiate and is not related to physical activities or positioning. She reports allodynia upon touching the affected area. Denies local trauma, skin changes, or previous infections at the site. She has used common analgesics (paracetamol, ibuprofen) without significant improvement.

Past Medical History: Hypothyroidism on regular use of levothyroxine. Denies other comorbidities.

Physical Examination:

General: Good general condition, hydrated, afebrile.

Neurological: Neurological examination without abnormalities.

Local: Area approximately 3 cm in diameter on the left parietal scalp, without erythema, edema, or visible skin changes. Local palpation reveals increased sensitivity, without palpable nodules or masses.

Complementary Exams:

Cranial MRI: Normal.

Laboratory tests (complete blood count, thyroid function, inflammatory markers): All within normal limits.