4.8.1 Probable nummular headache

A 55-year-old retired librarian reports a persistent headache confined to a single patch of her scalp that has troubled her for several weeks. She puts its size at somewhere between one and six centimetres across, and says the shape is oval rather than jagged. She reports that the patch has kept the same size and shape every day since it began, never growing, shrinking or changing contour. She adds that the ache simply fades gradually into the surrounding scalp rather than stopping at a clear line, so she cannot pinpoint its edge. She denies any change in vision, no nausea, no vomiting.