Trigeminal Neuralgia Evolving Into Nummular Headache

The patient is a healthy 66-year-old man with no previous headache history. He acutely developed a sharp, intermittent, retro-orbital pain, traveling into his left eye. There was no preceding head trauma, unusual physical exertion, seasonal allergies, or sinus disease. His right face was unaffected. The pain could also travel to the left occipital region. He denied any tearing or discharge from his left eye or his left ear, and he didn’t report any loss of taste or smell. Naproxen and ibuprofen failed to offer relief. The headache rapidly worsened in severity and frequency over 12 days, and he was hospitalized at our institution overnight after an acute worsening during coitus.