Differential Diagnosis for Scalp Tender to Touch
Single Most Likely Diagnosis
- Tension headache: This is often the most common cause of scalp tenderness, as the muscles in the scalp can become tense and painful due to stress or other factors.
Other Likely Diagnoses
- Scalp dermatitis (eczema or psoriasis): Inflammatory conditions of the scalp can cause tenderness and discomfort.
- Folliculitis: An infection of the hair follicles can lead to pain and tenderness in the affected area.
- Shingles (herpes zoster): Before the rash appears, patients may experience pain or tenderness in the affected dermatome, which can include the scalp.
Do Not Miss Diagnoses
- Meningitis: Although less common, meningitis is a serious and potentially life-threatening condition that can cause scalp tenderness, especially if accompanied by fever, stiff neck, and altered mental status.
- Subarachnoid hemorrhage: A severe headache (often described as "the worst headache of my life") can be associated with scalp tenderness due to irritation of the meninges.
- Temporal arteritis (giant cell arteritis): This condition can cause scalp tenderness, especially in older adults, and is associated with other symptoms like jaw claudication and visual disturbances.
Rare Diagnoses
- Trichodynia: A rare condition characterized by pain in the scalp, often associated with hair loss.
- Neuropathic pain syndromes: Certain conditions like trigeminal neuralgia can cause pain in the scalp, although this is less common.
- Metastatic cancer: Rarely, cancer that has spread to the scalp can cause tenderness, although this would typically be accompanied by other symptoms like a palpable mass.