Sunday, January 9, 2011

Family Medicine: Patient Parts and Patient Pain- Hair and Scalp

Patients tell us a lot about their parts and their pain.  We have to get the general situation and context to do our best thinking about parts and pain, then they fit better with therapeutic strategies.  We family physicians have a lot of training and experience dealing with parts and pain.  We share the patients desire to have less pain in fewer parts, or no pain in no parts.

If we start from the top, the hair roots may hurt if infected or the hair is pulled.  The scalp may hurt if traumatized or overused or overly sensitive to neck muscle spasms which can radiate pain to the scalp muscles (until it feels like your eyeballs are going to pop out).  Drug withdrawal can cause pain in the whole body, including the scalp.  The scalp may have excruciating pain such that you can't brush your hair without wincing in patients with temporal arteritis, which can lead to sudden blindness if not treated with steroids for a prolonged period of time (guaranteed to get steroid side effects like facial swelling, thinning bones, weight gain and elevated blood glucose).  Unusual viral infections may generate scalp pain also, sometimes with intense burning on only one side of the scalp similar to nerve pain in diabetic feet .

Then there's the shingles, herpes zoster, a delayed effect of childhood chicken pox that hides in the spinal cord until the most in-opportune time when it burns like fire for 7-12 days before breaking out in a rash.  Not just any rash, but one that is on only one side of the body (scalp in this case) in a narrow band, aligning with a dermatome (area served by one nerve) in blisters with a red base.  Every grandma and great-grandma in America can tell when a rash is the chicken pox (trunk first then it goes elsewhere) so most can carry over that wisdom to recognize the shingles rash.

Bad news on the shingles is that the pain may persist, after the rash is gone, intermittently forever.  This is called post herpetic neuralgia (PHN) happening about 6% of the time if you read the studies conservatively and possibly 30% if you own shares in a company that manufactures the "shingles" shot, which is available for people 60 and over for $250 (not covered by medical insurance).  The shot is only effective 14% of the time for 80 year olds, so the $250 may not be such a good investment for many.  It also may cause you to break out with the shingles.  In families that all get the shingles and the PHN, they are anxious to get the shot.

Also in shingles of the scalp it may move down across an eye onto the face, threatening vision loss and requiring evaluation by an ophthalmologist.  Bummer of a pain.

I've also seen scalp pain from staphyloccal infection of the hairline (sometimes methicillin resistent staph aureus: the famous MRSA) sometimes resulting from a haircut.  Burns of the scalp from accidents in hair salons also hurt and can make your hair fall out.

Unusual scalp pain might be caused by insect infestation, stings, bites or burrowing under the skin.   

Wow, we haven't got to the sinuses and face yet and I'm low on blog space.  I'll split parts and pain up and dole it out in bits over the next year or two.  Pain is a big deal in family medicine practice.  And it hurts.  And we care.


  1. :) Great title! and post.

    If 6-30% of people who had chicken pox get shingles, and the shingles vaccine is only effective 14% of the time for 80yo's, that sounds like there's very little point in people over 80 getting the vaccine. I'd be interested to know if it's worthwhile for those who are younger. And what about people who never had chicken pox? It seems that someone who's never had chicken pox doesn't have a possibility of reactivating something they never had. Then there's today's kids who now get vaccinated against the pox. From a shingles standpoint, when they get older are they at risk of getting shingles? (not asking for medical advice, just speculating different scenarios)

    I'm looking forward to reading more of this series.

  2. I just re-reviewed the CDC (Center for Disease Control) site "Prevention of Herpes Zoster" with the ACIP recommendations. Sifting through the fog, one finds an estimate that 32% of adults (80-85% of them over age 60) get shingles (at the most because this item is written with strong support of the immunization and LEANS STRONGLY toward presenting the worst case possible to casual readers, with many references to study data from the manufacturer of the zoster vaccine for shingles prevention). Immunocompromised persons aren't that lucky, though, 10 per 1000 person years in those with RA compared to 1 per 1000 person years in the general population get shingles. After 6 months of being observed in a large study or two, 5.1% of those with shingles still had pain, which is a reasonable, though not accurate, estimate of the highest percent possible of PHN (. So 5.1% of 32% = 1.63% of total adults who could get PHN, which is the most common reason for people to get the vaccine against shingles (herpes zoster).
    Fog thickens when there is money to be made. Thank you for the comments.

  3. I'm a 54 yr.old female RA patient who had the shingles vaccine and still got the shingles!!!! My scalp is still on fire. I found your blog while searching for scalp pain. I'm having blurred vision as well as overall pain. I went to a dermatologist who was only interested in cosmetic procedures instead of helping me with my outbreak. My rheumatologist said she should have put me on meds right away. All this money hungry dermo said was..oh u have very few wrinkles Except for the wrinkles from my eye that the shingles created!! Can you believe it. Ha. It seems young doctors in the dental and cosmetic practices are more interested in those areas of medicine because they have the greatest opportunities for more money. Sad.....sad.... What can I do for burning pain on the scalp??

  4. Anonymous, Your Family Physician treats shingles all the time, probably will be happy to see you and help.
    The pain of shingles is called neuropathic pain. Neuropathic pain is often treated with gabapentin.
    Good luck.

  5. If you want to know about the different types of the scalp infections then you can visit our blog post. If you are suffering from the severe baldness problem then it might be due to scalp infections.