Migraines, tension headaches, and autoimmune disorders like psoriasis can all cause the scalp to become inflamed, irritated, and painful. Sunburns, rashes, wounds, and insect bites also commonly cause scalp tenderness.
Most cases of scalp tenderness clear up on their own or with medication, but some are signs of an underlying condition.
Scalp tenderness is defined as pain, inflammation, tingling, numbness, irritation, itching, throbbing, or sensitivity of the scalp. Often, many of these symptoms appear together, being linked immune processes in response to a variety of conditions.
Some scalp tenderness is caused by conditions affecting the blood vessels, nerves, and tissues below or surrounding the scalp.
Often, there are no visible symptoms. Other times, scalp tenderness is painfully obvious, involving peeling, flaking, and scaling of the skin.
The prevalence of scalp tenderness is not known, but the symptoms are considered fairly common. Scalp tenderness can accompany common conditions such as headaches, allergies, psoriasis, eczema, and hair loss.
Scalp tenderness is linked with many forms of headaches. In particular, scalp tenderness is linked with headaches involving the nerves that run from the back of the neck to the forehead.
Conditions that cause these nerves to swell or restrict can result in pain that moves throughout the head, neck, and scalp. According to Johns Hopkins University, this pain can appear as hot, intense, electric-like shocks.
The scalp becomes so sensitive for some people that even a light touch can be painful. In others, the scalp goes numb. This form of nerve pain is rare and usually caused by injury or a spontaneously pinched nerve. Headaches involving these nerves are far more common, however.
Scalp tenderness is also frequently linked to a range of skin conditions including:
- insect bites
- head lice
Many of these conditions cause inflammation, pain, tenderness, flaking of the skin, peeling, and can even make the scalp pus or bleed.
Dandruff is a common complaint, affecting places of the body where natural oils collect. It can cause red, scaly patches on the scalp. While not a sign of poor hygiene or disease, many people seek treatment out of irritation or embarrassment. Rarely, dandruff can also be caused by fungal infection or ringworm.
Psoriasis of the scalp can also lead to scalp tenderness and flaking or crusting skin. Unlike dandruff, the skin is dry with a silvery sheen. Stress, hormones, dry air, or cold weather can trigger psoriasis.
Lichen planus can also cause the scalp to flake or scale. This condition is also usually brought on by periods of stress or as a side effect of medical treatments.
If extreme, many of these conditions can lead to reversible hair loss.
Alopecia and hair loss
A form of hair loss called alopecia areata can also cause scalp tenderness. In this condition, hair follicles fall out in round clumps from the scalp and sometimes the body.
Alopecia areata presents in patches, while alopecia totalis involves the loss of all hair from the head. Alopecia universalis involves hair loss from the entire body.
The National Institute of Health (NIH) claim that most forms of alopecia are generally not dangerous to the health or a sign of nerve damage. Instead, they are often the result of immune cells attacking hair follicles.
Other factors that can cause hair loss include:
- poor diet, especially one lacking in protein and iron
- therapies such as chemotherapy and radiation
Some women also experience reversible hair loss after childbirth, during hormone therapies, or during menopause.
In some instances of alopecia, the hair will likely regrow. With other forms, the hair follicle damage is so severe that hair loss is irreversible.
Other causes of scalp tenderness
Conditions that affect the skin elsewhere on the body can also present on the scalp. These include:
- allergic reactions
- infections of the skin cells or hair follicle shafts
- viral diseases that cause skin sores such as shingles and measles
- tight hairstyles, headbands, and helmets
- regular or improper use of hair products such as dyes and relaxers
- hair dryers, flat irons, and curlers
Brushing or rubbing the hair while it is wet can break hair follicles, causing hair loss and scalp irritation. Over-brushing can also cause problems.
While rare, scalp tenderness can be a sign of more severe health conditions such as skin cell cancers and melanomas. These conditions normally present themselves as new or changed moles or stubborn sores.
Especially painful, severe, or prolonged cases of scalp sensitivity should also be reported to a doctor.
It will normally take a few visits to resolve more persistent or severe conditions causing scalp tenderness.
Doctors often begin by collecting a medical history and asking questions concerning diet, routine, prior injuries, other conditions, and recent changes.
The doctor may then proceed to examine the scalp. They may also collect a hair follicle or scalp sample to be sent for further testing. Some doctors may also check body hair patterns.
In many cases, the conditions causing scalp tenderness go away on their own. Many also require basic cleaning and care to ensure that the area heals successfully.
Home first aid ointments, creams, antiseptics, and dressing materials are often enough to treat basic cases. Long-lasting or painful scalp tenderness should be reported to a doctor.
As so many conditions are linked to scalp tenderness and sensitivity, the course of treatment for each case can vary greatly. Treating the underlying cause of scalp tenderness typically treats the symptoms.
Some form of medicated cream or ointment is likely to be prescribed to manage irritation, pain, and external symptoms alongside other treatments. Medicated washes, shampoos, rinses, and conditioners are also commonly used to help treat scalp tenderness.
In the United States, Minoxidil and laser devices are available over the counter (OTC). Finasteride is another treatment approved the U.S. Food and Drug Administration (FDA). Studies have shown that it can slow hair loss in 80 percent of cases of hereditary male balding or thinning caused by certain conditions. Corticosteroids can also be prescribed for more general cases.
Patients should read directions fully before starting treatment.
If an infection does not clear after one treatment cycle, patients should seek further advice. The same advice applies to over-the-counter dandruff treatments. Pharmacists can help with choosing treatments and address concerns before starting either treatment.
Steps to take to relieve a tender scalp include:
- massaging the scalp with fingertips in circular motions
- applying ice for 10-minute intervals
- using tools to manipulate the scalp like
- slowly letting down hair that has been held in a tight position for a long period
Stretching and relaxation techniques can also be helpful for scalp tenderness caused by headaches, muscle soreness, and tension.
Preventing scalp tenderness
Following standard care routines can prevent many cases of scalp tenderness. Some things to avoid include:
- spending too much time in the sun
- hair-damaging chemicals, dyes, or devices
- intense stress