What Causes Scalp Tenderness?

A sore scalp or scalp sensitivity can be caused by a number of different health issues and other problems. Something as harmless as dermatitis can lead to scalp soreness, or something more serious, like an infection, may be the cause. If you’re wondering why your scalp is sore, read on to find out more about what could be causing it.

Woman with her hands in her messy hair

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Dermatitis

Dermatitis describes skin irritation and rashes. It can be caused by genetics, an overactive immune system, infections, allergies, and irritating substances. It can cause dry skin, redness, and itchiness in the affected area, including the scalp. People who have other skin conditions are more at risk for developing scalp sensitivity and pain.

Treatment

The type of dermatitis affecting your scalp will determine the most effective course of treatment. For example, if your scalp dermatitis is caused by an irritant or allergen, you can avoid contact with the products that cause the irritation and it will likely clear up.

In other cases, such as seborrheic dermatitis, treatment may involve over-the-counter (OTC) or prescription shampoos that contain ingredients such as:

  • Coal tar: This substance is derived from coal. Shampoos with coal tar can be used for seborrheic dermatitis twice a week. However, coal tar does come with the risk of contact dermatitis—skin irritation from direct contact with an allergen or irritant—so you should use it with caution.
  • Selenium sulfide: Selenium sulfide is an anti-infective agent that relieves itchy, flaky skin on the scalp. Shampoos containing this ingredient are used to treat seborrheic dermatitis and various scalp conditions that can cause tenderness or pain.
  • Tea tree oil: Tea tree oil comes from the melaleuca tree native to Australia. Tea tree oil shampoo can be used daily.
  • Zinc pyrithione: Zinc pyrithione is a compound that has antibacterial, antifungal, and antimicrobial properties that can help treat dermatitis on the scalp.
  • Topical antifungals: Shampoos containing ketoconazole or ciclopirox have antifungal and anti-inflammatory properties and can be used when scalp dermatitis is caused by a fungus.
  • Topical corticosteroids: Topical corticosteroids are anti-inflammatory medicines, such as betamethasone valerate and fluocinolone, that may be used to relieve scalp problems not caused by a fungus.

Infections

An infection occurs when a pathogen gets inside the body and causes illness. It can be caused by viruses, fungi, parasites, or bacteria.

Some types of infections can affect the scalp and cause scalp soreness and sensitivity. Folliculitis, furunculosis, and carbunculosis, for example, can cause scalp irritation and soreness.

Folliculitis is an infection of the hair follicles, while furunculosis can affect both the hair follicles and the glands that open into hair follicles, releasing oily and waxy substances to lubricate the hair. Carbunculosis occurs when boils (painful pus-filled bumps) form and group together underneath the skin due to an infection.

An infection of the hair follicles can lead to symptoms such as:

  • Red bumps on the scalp filled with white pus
  • Itching
  • Pain and soreness
  • Irritation 

When to See a Doctor

All types of scalp infections will need to be examined by your doctor. If you suspect that your scalp soreness is caused by an infection, make an appointment to see your doctor as soon as possible.

Treatment

Treatment for infections of the scalp can include:

  • Antibacterials: If bacteria are causing the infection on the scalp, the oral antibiotic Keflex (cephalexin) or the topical antibiotic cream Bactroban may be prescribed. For recurring infections, stronger antibiotics such as tetracycline or minocycline may be used for a longer period of time. In some cases, a mild cortisone cream is needed to help relieve the symptoms.
  • Antiparasitics: Research has shown that silicon oils known as dimeticones can be helpful in ridding the scalp of infections caused by mites, lice, and similar parasites.
  • Antifungals: Antifungals can come in both oral and topical formulas. If the fungus causing the scalp infection is ringworm, for example, treatment will typically involve oral antifungals, such as fluconazole, terbinafine, itraconazole, and griseofulvin.

For a mild case of folliculitis, home remedies such as an antibacterial cleanser or anti-itch creams can help. More severe cases will need antibiotics. If boils or carbuncles (clusters of boils) form on the scalp, you will have to get them drained by your doctor.

Psoriasis

Psoriasis is a chronic autoimmune disease that causes red, itchy, and scaly patches on the skin, including the scalp. It causes skin cells to multiply faster than they can shed.

Psoriasis affects the scalp of roughly 80% of people with the condition, and the scalp is usually one of the first areas to be affected. Besides itchiness and scales, psoriasis may also present with symptoms such as:

  • Cracked skin
  • Dry skin
  • Pain on the scalp

Treatment

Scalp psoriasis can be treated with the following:

  • OTC products: Products containing salicylic acid and coal tar can help ease the condition.
  • Topical corticosteroids: Certain medicated shampoos and other topical medications can be helpful in the treatment of scalp psoriasis. Ingredients shown to be effective include salicylic acid and clobetasol, which are topical corticosteroids in the form of lotions, creams, gels, foams, sprays, and oils.
  • Phototherapy: Phototherapy uses ultraviolet light to slow the growth of skin cells.
  • Dithranol: This medication controls the growth of skin cells so they do not multiply faster than they can shed.
  • Vitamin D analogs: Vitamin D may help slow the growth of skin cells.
  • Immunotherapy: Immunosuppressive medications may help counteract the overactive immune system in psoriasis. This type of therapy can help reduce flare-ups, times when symptoms worsen.

Sunburn

A sunburn results from too much exposure to the sun and skin damage develops as a result. If the sunburn occurs on the scalp, it can lead to pain and irritation in the area. Other symptoms of a sunburn include:

  • Redness on the scalp
  • Swelling
  • Blisters
  • Dry and peeling skin

If the burn is particularly severe, you may also experience weakness, confusion, faintness, dehydration, and shock.

Treatment

In most cases, sunburns can be treated at home. The skin will heal on its own, but it takes time. You can alleviate pain on your scalp by taking a cool shower or applying a cool, wet compress to your head. OTC pain relievers such as Advil or Motrin (ibuprofen) or Tylenol (acetaminophen) also may help with the pain. To reduce swelling, a mild moisturizing cream with aloe can be applied to your scalp.

You may want to avoid using certain shampoos or hair products that could cause further irritation. Products that contain benzocaine or similar ingredients ending in "caine," such as topical pain relievers, should be avoided since they can cause irritation.

Can a Sunburn Cause Hair Loss?

Sunburns on the scalp can be serious, but it is unlikely that they will lead to hair loss. If the skin does peel, you may lose some hair. However, once the area heals, those hairs will grow back.

Tension Headache

Tension headaches are the most common types of headaches. They typically occur behind the eyes and in the neck area. People who have tension headaches often describe the sensation as feeling like a tight band is wrapped around their heads.

During a tension headache, the muscles in the head and neck area contract, which leads to the pain. The pain that occurs during a tension headache is dull and pressure-like and is typically worse in the temples, back of the neck, and scalp. It can also cause scalp tenderness.

Treatment

The first course of treatment for tension headaches usually is OTC pain relievers such as ibuprofen, aspirin, naproxen (Aleve), or acetaminophen. Many people with this type of headache self-treat at home.

For some, tension headaches may be recurrent or chronic. Treatment for recurrent tension headaches is typically the tricyclic antidepressant amitriptyline.

There are some nonmedicinal ways to help treat a tension headache, including:

  • Hot and cold therapy: Using a hot or cold compress on the area can help relieve the pain of a tension headache.
  • Relaxation techniques: Tension headaches can be caused by stress, so learning relaxation techniques, such as deep breathing, meditation, and listening to soothing music, can help reduce the frequency of tension headaches.
  • Biofeedback: Biofeedback works by placing sensors on the body or head. These sensors then monitor physical reactions as a way to identify certain stressors, or tension-inducing feelings or situations, so you can learn to manage them.

Temporal Arteritis

Temporal arteritis is characterized by the inflammation and constriction of the temporal arteries (blood vessels) near the temples. The temporal arteries help move blood to the brain and head.

Temporal arteritis is a rare condition that typically affects adults over age 50. It more often is found in women than in men. It's not clear what causes the condition, but it’s thought that problems with immune response may be a factor.  

Temporal arteritis presents with various symptoms, the most common being a throbbing headache on one or both sides of the forehead that doesn’t go away. It can also lead to tenderness on the scalp or temples. Other symptoms may include:

  • Fever
  • Jaw pain
  • Vision issues
  • Muscles aches
  • Loss of appetite
  • Weight loss
  • Fatigue

Treatment

Temporal arteritis can be managed with medications. The first-line treatment is glucocorticoids, such as the medication prednisone, which can help reduce inflammation in the body.

Is Temporal Arteritis a Health Emergency?

Temporal arteritis, also referred to as giant cell arteritis or Horton’s arteritis, is a medical emergency that requires immediate medical help. If it is left untreated, it can lead to serious health complications that can be life-threatening.  

Fibromyalgia

Fibromyalgia is a pain disorder affecting the soft tissues. The exact cause is unknown, but contributing factors may include the abnormal processing of pain messages within the central nervous system, chemical imbalances, and genetics. It causes chronic and widespread pain, including on the scalp.

Other symptoms of fibromyalgia may include:

  • Anxiety
  • Depression
  • Digestive issues
  • Headaches or migraines
  • Issues with memory
  • Numbness and tingling in the hands or feet

Treatment

Treatment is focused on improving symptoms and overall quality of life. Typically, fibromyalgia presents with other conditions that cause it to flare up. Because of this, treatment of the symptoms of fibromyalgia coincides with treating comorbidities (other illnesses present), such as:

To help cope with the pain, a variety of medications can be used, such as:

  • Gabapentinoids: Gabapentinoids are a class of drugs made up of gabapentin and pregabalin and work by inhibiting certain neurotransmitters (chemical messengers in the brain) that cause pain. Examples of gabapentinoids used for fibromyalgia include Gralise (gabapentin) and Lyrica (pregabalin).
  • Sedatives: Sedatives such as Ambien can help people with fibromyalgia sleep better, which may improve their symptoms.
  • Antidepressants: Certain selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used for fibromyalgia pain. They regulate brain chemistry, particularly in areas affecting emotions and pain. When the levels of certain chemicals in the brain are changed, pain may be reduced by limiting the number of pain signals being sent.
  • Tricyclic compounds: Medications that contain both an antidepressant and a muscle relaxant may also be used. They regulate chemicals in the central nervous system to help lessen pain throughout the body.

Treatment may also include the use of pain-relieving medication such as ibuprofen, stress management techniques, and strength training or exercise.

Does Fibromyalgia Affect Your Hair?

Fibromyalgia affects the whole body and can cause changes that can lead to hair loss. Typically, the hair loss isn't permanent and is more prevalent during times when a person with fibromyalgia is under a significant amount of stress.

Hair Extensions

Hair extensions are used to add fullness or length to a person’s hair. The hair used can be synthetic or natural human hair. Extensions come in many forms and can be clipped onto the hair, glued on, or sewn in.

Hair extensions can cause scalp discomfort for a variety of reasons, including being adhered too tightly to the scalp, being too heavy, or containing an irritant that causes an allergic reaction. Hair extensions have been linked to headaches and hair loss as well.

Treatment

The treatment for scalp pain brought on by hair extensions is simply having them removed. There is no other way to relieve the pressure on the scalp than to take them out. It's possible that trying a different type of hair extension could help, especially for people who experience scalp discomfort due to an allergic reaction.

When to See a Doctor

If you experience symptoms such as a severe headache or a rash that appears on other parts of your body as well as your scalp, you should book an appointment to see your doctor.

Any scalp soreness that does not go away within one to two weeks should be further investigated by a medical professional. This includes soreness caused by dermatitis, psoriasis, fibromyalgia, and recurrent tension headaches. Some are chronic conditions that require ongoing management.

Temporal arteritis is a life-threatening condition and needs to be treated promptly at the first sign of symptoms.

Summary

A number of skin conditions like dermatitis, infections, and psoriasis can affect the scalp and cause tenderness. Other diseases that affect the head or blood vessels in the area such as tension headaches and temporal arteritis can also lead to scalp tenderness. Systemic conditions like fibromyalgia can cause scalp pain. Sometimes sunburns and hair extensions that are too tight or heavy can irritate the scalp, also.

Frequently Asked Questions

What kind of doctor do you see for scalp sensitivity and tenderness problems?

If you suspect that a skin condition is causing your scalp sensitivity, you will see a dermatologist. For conditions such as fibromyalgia, you may meet with a rheumatologist. For tension headaches and temporal arteritis, you may have to be referred to a neurologist. It depends on the cause.

If you’re unsure which doctor to see, book an appointment with your primary care physician, who may be able to treat your condition or refer you to a specialist.

What causes sensitivity to the touch on the scalp?

Tension headaches, infections, and skin disorders can all cause scalp sensitivity. In some cases, though, your scalp may be overly sensitive and has nothing to do with an underlying health issue. It’s best to ask your primary care physician for an assessment to rule out medical issues that could cause a sensitive scalp.

How can I reduce my scalp sensitivity?

The first thing you must do is to find out what is causing the sensitivity because treatment depends on the cause. You can take good care of your scalp like brushing your hair gently, changing shampoos if you suspect that your current one is irritating your skin, and ensuring that all hair products are completely rinsed from your hair. 

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