Nummular headache associated to arachnoid cysts.

A 52-year-old woman suffered a subarachnoid haemorrhage (SH) that caused cephalalgia without focal neurological abnormality. A four-vessel angiography revealed no vascular malformations but a right posterior parietal AC was found. High blood pressure was demonstrated and treated. Shortly after the SH, she started feeling a sore pain over a circumscribed area of the right parietooccipital scalp (Fig. 1a), where a 2.5 cm, coin-shaped area of tenderness and dysesthesia was detected, while neurological examination was normal. A MRI confirmed a 3 9 2.5 9 3 cm parieto-occipital AC (Fig. 1b). Several treatments, including gabapentin, indomethacin and amitriptyline were unsuccessful. She refused to be treated with botulinum toxin injections and rejected the cyst’s surgical removal. After 4 years no changes have occurred in her clinical, neurological or imaging findings.