Most of us have experienced banging headaches, when a grey mist descends and we feel like we need to lie in a dark room with the curtains firmly closed. But what about hair aches? When your hair itself (or the scalp directly beneath it), feels stingy, pulsing or downright painful?
Whether from malfunctioning skin (bacterial and fungal infections), or overzealous hairstyles pulled too tight against our head, there’s numerous reasons that can lead to sore hair, so we consulted the hair and health experts to get down to the root cause of the problem.
Are tender scalps common?
“The scalp is relatively prone to soreness, rashes, pain, and sensitivity, for several reasons. Firstly it is generally covered in hair, a feature that can encourage clumping of skin cells, and trapping of moisture. This makes infections and parasitic infestations more likely,” says Dr Clare Morrison, GP and medical advisor at Medexpress. “In addition, it is more exposed to the elements than most parts of the body, and may be damaged by extreme temperature changes and wind. In those with hair loss there is also the damaging effect of sunlight to consider,” she adds.
Do different areas of tenderness suggest different causes?
“Soreness at the back of the scalp, particularly with itching, may indicate head lice. Psoriasis can affect any part of the scalp, but can also spread beyond it, including the neck, forehead, and behind the ears. Fungal infections tend to affect the hair follicles and hair shafts. As well as the scalp, they can also affect the eyebrows and eyelashes,” says Dr Clare.
“Pain over the temple, right at the front of the scalp, may indicate a serious condition called ‘temporal arteritis’. This is an inflammatory condition of the temporal artery. It mainly affects elderly people, and can lead to blindness if not caught early,” adds Dr Clare, but it’s rare and shouldn’t be cause for concern unless the pain persists and is accompanied by other symptoms such as double vision, fatigue and loss of appetite.
If you experience tender at the hair margins, it may be worth taking a look at the way you wear your hair, since “this may be due to traction,” says Zoë Passam, trichologist at Philip Kingsley.
What are the main causes?
The main causes of scalp pain are as follows, says Dr Claire:
“Bacterial infections
Impetigo (causing a crusty inflamed rash), boils (tender swellings, which may become pustular), and folliculitis (multiple sore spots), are the most common types of bacterial infection affecting the scalp.
Fungal infections
These include ‘tinea capitis’ and ‘tinea versicolor’, which are quite common, particularly in children, and lead to patches of scaly skin on the scalp. Sometimes they are circular in shape and may be referred to as ‘ring worm’, (though they are not related to worms!)
Fungal infections can cause temporary hair loss.
Skin conditions
The most common skin conditions that affect the scalp, are dermatitis and psoriasis, in the same way as elsewhere. Dermatitis will cause redness and itching. Psoriasis causes thick scaly patches.
Allergies
These are a big problem for the scalp, as we expose this area to a multitude of skin products, including shampoo, conditioner, hair dye, hair spray, and other treatments. The symptoms include itching, redness and sometimes swelling, which may spread to the face and around the eyes, in severe cases.
Neuralgia
This sharp stabbing pain can often affect the scalp. Sometimes it’s caused by trapping of the nerves coming from the neck, for example with bad neck posture, or arthritis. Occasionally nerve pain comes on without any obvious explanation. It can be severe and persistent.”
Another cause of scalp tenderness is tension in the arrector pili muscles, the tiny muscles next to each hair follicle, responsible for giving us goosebumps, explains Zoe. “This condition is thought to be stress related,” she says but since we all have hairs, hair follicles and therefore arrector pili muscles, it’s not uncommon.
“Scalp tenderness can also occur due to tight hair styles. Tenderness and pain in this context indicates that the follicles are being put under an unacceptable amount of tension, which can lead to traction hair loss, which may become permanent,” adds Zoe.
Is it anything to worry about?
“Scalp tenderness due to tension in the arrector pili muscles is no cause for concern, and is not associated with hair loss, although it can be quite uncomfortable, for example when brushing/combing, or the wind blows,” says Zoe.
In general, scalp soreness, is “rarely serious,” says Dr Clare, “but it’s important to establish the cause. If there are symptoms beyond the scalp, such as fever, malaise, or swelling, for example, medical attention should be sought. Likewise, if the condition doesn’t respond to simple measures, or persists for more than a few days, then do seek help.”
How can we treat it?
“Firstly remove any obvious cause. Stop using any products that seem to trigger problems. Keep your head warm in cold weather, and protect the scalp from too much sun or wind,” says Dr Clare.
“Mild scalp conditions may be treated with medicated shampoo. Ones containing coal tar are quite useful at reducing inflammation and getting rid of fungal infections, as are specific anti-fungal shampoos. Conversely, if the scalp seems to be very sensitive, stick to a gentle shampoo, such as those suitable for babies and children. Regular combing with a fine toothed comb (after applying plenty of conditioner), is the best way to eradicate head lice,” adds Clare.
In the case of tension in the arrector pili muscles, it can be relieved to some extent by massage, “although this should only be done when a hair or scalp mask has been applied, to avoid undue stress on the hair,” says Zoe. “Cold rinsing may have an adverse effect, so always be sure to wash your hair using only warm water. Since stress can be a trigger, taking steps to manage stress levels may also be helpful,” she adds.
“Scalp tenderness from tight hair styles is easily avoided by more gentle hair styling techniques, and if wearing the hair up, varying the hair style from one day to the next,” advises Zoe.
What should we do if the problem persists?
If the problem persists, seek help from your GP or a trichologist. “They will be able to help with diagnosis, and give advice,” says Dr Clare. “If necessary, you may be prescribed treatment, such as antibiotics, or topical treatments such as a steroid lotion.