Is scalp pain also considered a headache?

This is the 4254th article of Da Yi Xiao Hu

Xiao Wang has been feeling severe scalp pain these past two days, like being pricked by needles, sometimes burning and a little itchy. After a careful examination at the hospital, it turned out to be herpes zoster. Is scalp pain also considered a headache? Yes, most scalp pain is caused by secondary reasons. Today we will talk about two types of scalp pain that are often encountered in the neurology clinic - herpes zoster and occipital neuralgia.

1. Scalp pain secondary to herpes zoster

The skin area of ​​the head near the forehead, bounded by the line connecting the two ears, is governed by the first branch of the trigeminal nerve. If herpes zoster affects the first branch of the trigeminal nerve, it can cause burning pain, tingling or lightning pain in the local skin. Some people also experience numbness, accompanied by abnormal skin pain, which is common in patients with impaired immune systems. The third edition of the International Headache Classification classifies it into two types: painful trigeminal neuropathy due to herpes zoster and postherpetic trigeminal neuralgia.

The typical pain of patients with postherpetic neuralgia usually manifests as burning and itching. Obvious sensory loss and mechanical hyperalgesia induced by brushing teeth may occur in the distribution area of ​​the affected trigeminal nerve. Most patients rarely experience sensory loss, but instead experience strong pain reactions to heat and/or point stimulation. Physical examination shows local red raised herpes, and auxiliary examinations show positive varicella-zoster virus antigen or PCR test for varicella-zoster virus DNA. Antiviral drugs such as ganciclovir and famciclovir are given for treatment, which can be taken orally or topically. Interferon can be added for treatment in severe cases. At the same time, pay attention to rest, try to avoid secondary bacterial infection after scratching, and give symptomatic analgesics for pain, such as pregabalin and analgesic tablets.

2. Occipital neuralgia

In the neurology clinic, we often see some patients with pain under the skull near the base of the ear at the back of the head. The pain can be improved after massage, which is especially obvious after sitting in an improper posture. In this case, we should be alert to the possibility of occipital neuralgia. Occipital neuralgia usually occurs in the back of the scalp, with unilateral or bilateral paroxysmal tearing or tingling pain in the distribution area of ​​the greater occipital, lesser occipital and/or third occipital nerves, sometimes accompanied by loss of sensation or dullness in the affected area, usually accompanied by tenderness of the affected nerve. The pain is generally severe and recurrent. The paroxysmal pain lasts from seconds to minutes. The pain can be tearing, tingling or sharp. Benign stimulation of the scalp or hair can cause obvious hypoesthesia or tenderness. Occipital neuralgia needs to be differentiated from the following pains: occipital radiating pain caused by the atlantoaxial joint or the upper cervical articular process, and occipital radiating pain induced by the tender points of the neck muscles. Generally, the corresponding imaging changes can be seen in MRI examination of the cervical spine. Treatment includes oral analgesics, local massage therapy and other rehabilitation measures. Nerve local anesthetic blockade can also temporarily relieve pain.

Have you ever experienced scalp pain like the above? Knowing these two common causes can help you reduce the chance of misdiagnosis and quickly identify them when it is inconvenient to see a doctor. Spring is the season when viruses are active. I hope you can strengthen physical exercise, improve your immunity, and don't give viruses a chance to invade your body.

Author: Department of Neurology, Second Hospital of Jilin University

Man YuhongChief Physician