Burning vertex syndrome: a novel unclassified headache - its preliminary observations, and possible mechanisms

Not all headaches are fully defined or characterized by the current classification systems. The variability in headache descriptions and presentation may be influenced by individual or group factors, or may even suggest the discovery of a new or an atypical phenotype. This paper aims to describe a novel headache syndrome characterized by a burning sensation on the vertex.

Demographic and clinical profiles of 25 patients from a referral headache center in India were analyzed. The syndrome presents as episodic, burning headaches on the vertex (10-20 cm diameter). Most patients were women (16/25), with a mean age of 40.96 years (SD+ 0.75). Episodes occurred 1-3 times weekly or daily, lasting <4 h (range: 1 min to 24 h). Associated symptoms included nausea, vomiting, photophobia, phonophobia, or autonomic features (76%). Common comorbidities were hypertension, diabetes, and polycystic ovarian disease. Neurological exams were normal, except for a slight local temperature rise in 2 patients. Treatment responses varied, though two patients reported reduced frequency and severity after greater occipital nerve (GON) block.

This syndrome is not completely compatible with any other primary headache disorders like nummular headache, migraine, cluster, or tension-type headaches. It potentially involves small fiber pathways from the scalp. Further studies are needed to better understand its clinical features, gender predilection, mechanisms, biomarkers, and treatment options.