"I feel an irresistible urge to bang my head against the wall": a case series highlighting agitation and severe pain in cluster headache

Abstract

Introduction

Paroxysmal cranial sensations without pain are infrequently described and remain poorly classified in current headache nosology. While disorders such as primary stabbing headache and epicrania fugax produce brief, sharp pain, non-painful paroxysms of the scalp are rare and understudied. We report a case of recurrent, brief, non-painful thumping (or “blow”) sensations at the vertex, persisting for seven years, to broaden awareness of atypical cranial sensory phenomena.

Case Report

A 60-year-old woman presented with a 7-year history of recurrent, spontaneous sensations she described as a “thump” or “blow” localized to the vertex. Individual episodes lasted ~2 seconds and recurred approximately once monthly. The patient denied any associated pain, auditory phenomena, visual disturbance, dizziness, nausea, or aura. Episodes occurred in diverse positions (lying, sitting, walking) and were not precipitated by head movement or Valsalva maneuvers. During events she briefly stopped activity due to a transient fear of imbalance but did not fall. Medical history was unremarkable for hypertension, diabetes, tobacco use, trauma, or recent illness. Neurological examination was normal. No focal deficits, post-ictal signs, or autonomic features were observed.

Comment and Conclusion

This  presentation does not fit established ICHD-3 entities and likely represents a benign, focal paroxysmal sensory phenomenon localized to the scalp. Differential diagnoses include atypical primary sensory paroxysm, focal sensory epileptic discharge, and brief peripheral neuropathic events; however, the stereotyped, nonpainful, ultra-brief nature and long stability favor a benign primary sensory paroxysm. Reporting such cases can help refine classification and stimulate research into the pathophysiology of non-painful cranial paroxysms