4.8 Nummular headache

**Identification:**
32-year-old female patient, teacher, with no known prior comorbidities.

**History of Present Illness:**
The patient reports a 6-month history of pain localized in the left parietal region, approximately 3 cm in diameter, described as "a circle of pain." The pain is continuous, with moderate intensity (6/10), with periods of exacerbation (8/10), associated with tenderness to touch in the affected area. She reports partial relief with common analgesics (paracetamol and ibuprofen), but without complete resolution. Denies local trauma, skin changes, or recent infections in the area. Reports that the pain interferes with sleep and daily activities.

**Past and Family History:**
Negative for a history of chronic headaches, migraines, or other neurological diseases. No relevant family history.

**Physical Examination:**
- General: Patient in good general condition, afebrile, hemodynamically stable.
- Neurological: Neurological examination without focal deficits. Normal reflexes, preserved muscle strength, intact sensation (except in the painful area).
- Painful region: Well-defined area on the scalp, without erythema, edema, or visible skin changes. Local palpation triggers intense pain.

**Complementary Exams:**
- Cranial magnetic resonance imaging: No structural alterations or focal lesions.
- Laboratory tests (complete blood count, C-reactive protein, ESR): Within normal limits.