Why does my scalp hurt? Related conditions and treatments

In this article:

• What causes scalp pain?
• Should I be worried about scalp pain?
• How is the cause of scalp pain diagnosed?
• How long does scalp pain last?
• How to stop scalp pain
• Living with scalp pain 
• Bottom line

In this article

• What causes scalp pain?
• Should I be worried about scalp pain?
• How is the cause of scalp pain diagnosed?
• How long does scalp pain last?
• How to stop scalp pain
• Living with scalp pain 
• Bottom line

The most common causes of scalp pain and tenderness are inflammation, headaches, nerve-related diseases, and fungal infections. And, in people who have a sensitive scalp, some irritants in hair products like shampoos, relaxers, soaps, oil, dyes, and even changes in weather can contribute to that feeling of pain. Depending on the cause, scalp pain may feel like pressure or a numbing, stabbing, or burning pain. It may also feel itchy or like a tingling sensation. Symptoms that may accompany scalp pain include headaches, itchiness, scaly patches, and dandruff.

What causes scalp pain?

Anything that activates the pain receptors in a person’s scalp or head can trigger scalp pain. The causes of scalp pain differentiated by origin include headache disorders, vascular disorders like temporal arteritis, skin inflammation and infections, and environmental and lifestyle factors.

1. Nerve conditions

“Nerve-related scalp pain can come from conditions like occipital neuralgia or trigeminal neuralgia, where nerves in the scalp become irritated or inflamed, leading to sharp or shooting pain,” says Andrei P. Gherghina, MD, board-certified dermatologist and co-founder of OCEANS dermatology in Boynton Beach, Florida. Occipital neuralgia is a headache disorder that causes sharp burning pain or shock-like pain in the upper neck and head. Trigeminal neuralgia is an electric shock-like pain that is felt on the face. Both nerve conditions can trigger pain sensations in the scalp. Shingles is yet another source of scalp pain arising from angry nerve endings, but it is accompanied by a blistering rash.

2. Nummular headaches

Nummular headaches are sometimes referred to as coin-shaped headaches because they’re characterized by pain that is prominent on a small coin-shaped area on any part of the scalp. The cause is unknown. The scalp pain varies from mild to moderate and, occasionally, severe. Pain may be pressure-like, stabbing, or burning. Nummular headaches can be periodic or chronic—subjects in one study averaged three attacks per day with a frequency of 10 affected days per month. 

3. Tension headaches

Tension in the muscles between the head and neck may cause mild to moderate headaches, known as tension headaches, and it may eventually lead to pain in the scalp. It is characterized by dull, pressure-like pain felt all around the head but more severe in the scalp, temples, or back of the neck. Tension headaches can be caused by stress, depression, head injury, anxiety, sinus infections, flu, smoking, and dental problems. It can affect anyone of any age but is mostly seen in older teens and adults. Additionally, women have a higher risk of tension headaches.

4. Temporal arteritis

Temporal arteritis is a condition that occurs when there is inflammation, swelling, tenderness, or damage to the blood vessels (temporal arteries) that supply blood to the head, neck, upper body, and arms. It is also known as giant cell arteritis and is more prevalent in people with an inflammatory condition called polymyalgia rheumatica. Temporal arteritis may be characterized by symptoms such as scalp tenderness or sensitive scalp, throbbing headache on one side or at the back of the head, jaw pain, and vision loss. This condition has no known cause, but it may have an underlying cause that has been linked to immune reactions, infections, and gene mutation. Temporal arteritis requires immediate medical attention and treatment to prevent vision loss and blood vessel damage.

5. Folliculitis

One of the causes of scalp pain is folliculitis. “Folliculitis is inflammation of the hair follicles, which is usually caused by bacteria or fungi,” Dr. Gherghina says. “If you have scalp folliculitis, you may have itchy lesions on the scalp that may become sore and crusty from constant scratching. Overall, the outlook for recovery is good with appropriate care,” Dr. Gherghina says. 

6. Seborrheic dermatitis

Seborrheic dermatitis is a common inflammatory skin disease that affects oily parts of the body, including the scalp, back, chest, and face. Seborrheic dermatitis causes dry, itchy, and inflamed scaly patches to form on the scalp. The itchiness and inflammation may cause scalp pain. The noninflammatory version is known as dandruff. There are other types of dermatitis that could cause scalp pain as well:

• Atopic dermatitis, or eczema, makes the skin, including your scalp, feel dry, red, and itchy.
• Irritant contact dermatitis occurs when your scalp comes in contact with strong irritants that may lead to inflammation.

7. Scalp psoriasis 

If you have thick, scaly, dry, itchy, discolored (red, brown, gray, or purple) plaques on your scalp and its surrounding skin, it may be due to a skin condition known as scalp psoriasis. “Scalp psoriasis is a chronic immune-mediated condition characterized by red, scaly patches on the scalp,” Dr. Gherghina says. In worse scenarios, scalp psoriasis may lead to hair loss, especially if the affected person is always scratching the plaques. “Treatment often involves topical medications, medicated shampoos, and, in some cases, systemic therapy. Management requires ongoing care but can effectively control the condition for many patients,” says Dr. Gherghina. 

8. Scalp infection

Scalp pain causes may also include infections such as scalp ringworm or tinea capitis—a fungal infection that causes itchy, dry, scaly patches on the scalp. Tinea capitis may also cause large, painful, inflamed, swollen, pus-filled patches called kerion on the scalp. Kerion is often characterized by blisters and abscesses (pockets of pus) and may lead to hair loss. It is best to see a healthcare provider if this happens. Treatment may include antifungal medications.

9. Environmental triggers

Scalp pain causes may include environmental factors, which are easy to remedy by simply avoiding them. For example, some chemicals found in hair dye, relaxers, shampoos, soaps, herbal oil, water, and some hair treatment products can cause scalp pain. “Hair care products and treatments that are loaded with chemicals can induce scalp dermatitis, a condition characterized by an itchy, swollen, painful scalp. Regular use of these substances may instigate chronic damage, consequently leading to enduring pain or discomfort in the scalp,” says Sarah Roberts, licensed hair specialist and founder of A Beauty Edit. 

Physical environmental factors such as ultraviolet radiation (sunburns), heat, cold, wind, and weather changes may also cause scalp pain in individuals who have sensitive skin.

10. Hair extensions

Some hair extensions can be very heavy and pull on the scalp. Some types of hairdos also contribute to scalp pain. Traction alopecia—a type of hair loss due to prolonged tension on the hair shaft—can result from chronic tight hairstyles, such as ponytails and braids. This may subsequently lead to noticeable scalp pain. Likewise, frequent use of heat tools at high settings can inflict thermal trauma upon the scalp. 

Should I be worried about scalp pain?

Scalp pain is a fairly common occurrence and should not be a source of worry unless it’s accompanied by inflammatory symptoms such as scaly, inflamed, and itchy patches or pus-filled lesions, which, if untreated, may eventually result in hair loss. The best thing to do in such cases is to see a dermatologist or trichologist—a specialist who treats hair and scalp problems. Additionally, you should see your primary care provider if scalp pain is accompanied by throbbing headaches. 

How is the cause of scalp pain diagnosed?

When you visit your healthcare provider for scalp pain, they may need to run some tests to diagnose the actual cause of your pain. These tests include:

• A physical examination of the skin on your scalp
• Examination of plucked hairs or scaly patches from the scalp
• A Wood’s light examination (use of ultraviolet rays to study the scalp)
• A culture test (a type of lab investigation that gives room for microorganisms like bacteria or fungi to grow)

Results will inform the healthcare provider’s diagnosis and possible treatment options.

How long does scalp pain last?

How long your scalp hurts will depend on the cause. It may last a few hours if it’s a minor issue that can be resolved on its own or with the help of NSAIDs. However, serious scalp pain that lasts longer than a few hours and is accompanied by fever or pus—signs of infection— may demand proper medical care. 

How to stop scalp pain

Generally, scalp pain treatment depends on its causes. With reference to the causes of scalp pain in this article, here are possible treatment options that might help you get relief: 

• Trigeminal neuralgia can be treated with nerve pain medications like carbamazepine, while occipital neuralgia is treated with massage, steroid injections, and surgery.
• Nummular headaches are treated with NSAIDs, gabapentin, tricyclic antidepressants, and botulinum toxin type A.
• Tension headaches may be treated with muscle relaxers, over-the-counter (OTC) pain medicines, such as aspirin, ibuprofen, or acetaminophen, and tricyclic antidepressants.
• Temporal arteritis is treated with corticosteroids, such as prednisone, and biologic medicine, such as tocilizumab.
• Folliculitis can be treated with shampoos containing antifungal agents such as ketoconazole or ciclopirox. 
• Seborrheic dermatitis is treated with 1% to 2% ketoconazole, 1% ciclopirox, 1% zinc pyrithione, and 1% hydrocortisone.
• Scalp psoriasis can be managed with corticosteroids, salicylic acid shampoo, and medications such as cyclosporine, methotrexate, and acitretin. 
• Tinea capitis can be treated with antifungal medications.

Living with scalp pain 

Some causes of scalp pain can be managed with natural remedies and lifestyle changes. For example, some people have sensitive scalp (hyperreactive and irritable skin), so it’s normal for them to experience scalp pain with little exposure to an irritant in the environment. Here are six simple ways to protect your scalp and keep it healthy: 

• Be conscious of allergic reactions. Before purchasing any hair product, check that you’re not allergic to any of the ingredients.
• Avoid harsh shampoos. Some contain chemicals that cause skin irritation and damage the hair and scalp. Instead, choose gentle shampoos made with natural ingredients. Special shampoos like antifungal shampoos may be the best if your scalp pain is due to a fungal infection.
• Have a proper hair care routine. This can include scalp massage with natural oils. Additionally, be sure to wash and condition your hair regularly. The recommended frequency varies, but not washing enough can lead to seborrheic dermatitis. 
• Protect your scalp from sunburn and harsh weather conditions by wearing a hat or scarf.
• Limit the use of heat styling tools. “When you do use them, ensure they’re set to their lowest heat settings. Opt for natural drying whenever possible since it’s healthier for your hair and scalp,” Roberts says.

Bottom line

Scalp pain typically resolves on its own, but if it doesn’t, avoiding environmental triggers and practicing scalp hygiene should help. But if it continues, worsens, or is accompanied by swollen pus-filled patches, it could be a sign of inflammation and require treatment. Only your healthcare provider can rule out infection or other serious health conditions like nummular headaches, tension headaches, temporal arteritis, and nerve-related conditions.