Scalp Pain: Why Your Scalp Hurts

What scalp pain feels like

People describe scalp pain as tenderness when brushing hair, a bruised feeling, burning, stinging, tingling or electric shocks. The type of pain and where it is located are the best clues:

Common causes

Headaches

During a tension headache or migraine, the scalp often becomes tender. In migraine, the nervous system becomes so sensitized that normally painless touch hurts: brushing hair, wearing glasses or resting your head on a pillow. This is called allodynia.

Tight hairstyles and headwear

Tight ponytails, braids, buns, extensions and weaves pull on hair follicles, causing soreness and, over time, hair loss along the hairline (traction alopecia). Tight hats, headbands and helmets cause pressure pain.

Skin conditions

• Seborrheic dermatitis: greasy, yellowish flakes and redness, sometimes sore. See seborrheic dermatitis.
• Psoriasis: thick, silvery plaques that can crack and hurt.
• Folliculitis: small, tender, pus-filled bumps around hair follicles.
• Contact dermatitis: burning and redness after hair dye (especially PPD), bleach, relaxers or new products.
• Sunburn on the scalp, especially along a part line or with thinning hair.
• Fungal infection (tinea capitis): scaly patches with broken hairs, mostly in children.
• Head lice: itching more than pain, but scratching can make the scalp sore.

Nerve causes

• Occipital neuralgia: irritation of the nerves running up the back of the head causes sharp, shooting or throbbing pain from the base of the skull over the scalp, often on one side, with tenderness when pressing the base of the skull.
• Shingles: shingles can affect the scalp and forehead. Burning, tingling pain on one side comes first, then a band of blisters a few days later. Pain can persist afterward (postherpetic neuralgia).
• Scalp dysesthesia: burning or itching of the scalp with no visible cause, often linked to neck problems or stress.

Serious cause: giant cell arteritis

Giant cell arteritis (also called temporal arteritis) is inflammation of the arteries of the head, almost always in people over 50. Signs include:

• a new headache, usually at the temples
• scalp tenderness, for example when combing hair
• pain in the jaw or tongue when chewing
• a tender, thickened artery at the temple
• vision problems such as blurring, double vision or brief loss of vision
• tiredness, fever, weight loss, and shoulder and hip stiffness

It can cause sudden permanent blindness, so it is treated with high-dose steroids as soon as it is suspected, often before tests confirm it. Blood tests (ESR, CRP), an ultrasound or biopsy of the temporal artery confirm the diagnosis.

Other causes

• Injury: bumps, cuts and bruises
• Infected cysts or boils
• Hair loss conditions: some scarring alopecias, such as lichen planopilaris and frontal fibrosing alopecia, cause burning and tenderness
• Skin cancer: rarely, a painful sore or lump on a sun-damaged scalp

How doctors find the cause

A doctor will ask about the type and location of the pain, headaches, hair care and products, rashes, vision and jaw symptoms, and your age. They will examine the scalp, hair, temporal arteries and neck. Tests depend on suspicion: blood tests for inflammation in people over 50, a skin scraping for fungus, swabs from infected bumps, or a scalp biopsy for hair loss conditions.

Relief and treatment

• Loosen up: wear hair down or in loose styles, and take breaks from tight headwear.
• Treat headaches: over-the-counter pain relievers such as ibuprofen or acetaminophen (paracetamol), following the label dose and using them no more than 2 to 3 days a week to avoid medication-overuse headache. Stress management, sleep and regular meals help.
• Medicated shampoos: ketoconazole, selenium sulfide, zinc pyrithione, salicylic acid or coal tar for dandruff and psoriasis.
• Soothe the skin: cool compresses, fragrance-free products, and aloe vera for sunburn.
• Stop irritating products and do a patch test before using hair dye.
• Antivirals for shingles started within 72 hours of the rash.
• Nerve pain: occipital nerve blocks, nerve pain medicines and physical therapy for neck posture.
• Steroids for giant cell arteritis, started urgently.
• Sun protection: a hat or scalp sunscreen.

Frequently asked questions

Why does my scalp hurt when I touch it?

A scalp that hurts to touch is often due to a tension headache or migraine making nerves oversensitive. Tight hairstyles, sunburn, folliculitis and dermatitis are other common causes. In people over 50, new scalp tenderness with headache should be checked for giant cell arteritis.

Can stress cause scalp pain?

Yes. Stress tightens the muscles of the scalp, neck and shoulders, triggering tension headaches and scalp tenderness. Stress can also worsen seborrheic dermatitis, psoriasis and scalp dysesthesia, a burning scalp without a visible rash.

What does a burning scalp mean?

A burning scalp can come from sunburn, a reaction to hair dye or products, shingles, seborrheic dermatitis or nerve irritation. If burning on one side is followed by blisters, it is likely shingles. Burning without a rash may be scalp dysesthesia.

Can a tight ponytail cause scalp pain?

Yes. Tight ponytails, braids and buns pull on hair follicles, causing soreness and headaches. Over time, constant pulling can cause permanent hair loss along the hairline, called traction alopecia. Loosening hairstyles usually relieves the pain within a day or two.

When should I worry about scalp pain?

See a doctor the same day if you are over 50 and have new headache, scalp tenderness, jaw pain or vision changes. Get emergency care for a sudden severe headache or one after a head injury. Persistent pain, hair loss or sores also need assessment.