Cephalgia Alopecia

Purpose of review: In this review, we examine reported cases of cephalgia alopecia including the initial case report from 2006. The goal is to review the clinical description, pathophysiology, diagnosis, and treatment of cephalgia alopecia.

Recent findings: The pathophysiology of the headache and hair loss in cephalgia alopecia is believed to be related to neuroregulation of skin and nerve. It is hypothesized that the headache causes recurrent activation of trigeminal and upper cervical branches that innervate the hair cells. The repetitive activation of C fibers results in depletion of substance P and calcitonin gene-related peptide (CGRP), which leads to loss of hair growth promotion and disruption of immune system regulation. A case report suggests that cephalgia alopecia and nummular headache with trophic changes may represent a spectrum of disease involving head pain and cutaneous changes. Cephalgia alopecia is a rare headache disorder described as recurrent burning, stabbing head, and neck pain that is followed by hair loss in the corresponding region of the scalp. The mainstay treatment for both pain and hair loss is OnabotulinumtoxinA (onabotA). A patient's clinical history and response to onabotA treatment is used to make the diagnosis. Future research is needed to examine the hypothesized disease continuum of head pain and cutaneous changes. It will also be beneficial to assess if the grid-like onabotA technique used in nummular headache is effective in cephalgia alopecia. In addition, further studies are needed to assess the proposed pathophysiology.

Keywords: Alopecia areata; Cephalgia alopecia; Headache; Nummular headache.