Kindly explain the reason for my scalp tenderness.

Hello,

Welcome to icliniq.com. Thanks for giving such an elaborate information and history (attachment removed to protect patient identity). Scalp tenderness is a common symptom of migraine headache. It can be associated with hemicranial headache or it can be a sole symptom of migraine. Though there are more other causes of scalp tenderness, in your case with a background history of migraine that seems to be the cause. If migraine headache is very frequent, then it gets converted as chronic daily headache or in use frequent analgesics it can convert into medication overuse headache. Pregabalin can cause some sedation. But, if started in low dosage and gradually increase, then sedation either does not occur or if occur lasts for three to five days only. Gabapentin is a good alternative to Pregabalin, which cause very minimal sedation. Left leg numbness can be meralgia paresthetica (numbness or pain in outer thigh due to nerve injury), but need investigations for that. The probable cause is poorly treated migraine or irregular treatment. Investigations to be done are 1. Nerve conduction study of bilateral lower limbs, including bilateral lateral cutaneous nerve of thigh. 2. Magnetic resonance imaging (MRI) brain and MR angiogram intracranial vessels with contrast. 3. ANA (antinuclear antibody), ESR (erythrocyte sedimentation rate), HBsAg (hepatitis B surface antigen), Anti HCV (hepatitis C virus), CRP (C-reactive protein) and fundus examination to look for papilledema. The differential diagnosis include 1. Migraine headache leading to chronic daily headache. 2. Giant-cell arteritis (temporal arteritis). 3. Insomnia due to chronic daily headache. The probable diagnosis is migraine headache. The treatment plan include getting nerve conduction study as advised above. If it suggests meralgia paresthetica, then try Gabapentin in place of Pregabalin. Rule out other causes of scalp tenderness by MRI and blood tests. If the tests come out be normal, then start appropriate prophylactic medications for migraine. The preventive measures include 1. Avoid trigger factors of migraine headache. 2. Do not wear tight belt at waist.

Hi,

Welcome back to icliniq.com. Many times, migraine are waxing and waning in nature. And the scalp tenderness and dull headache seems a type of migraine headache. If the previous magnetic resonance imaging (MRI) brain was done with contrast, you can skip new MRI. But, if the previous one was without contrast, then I suggest you get another MRI brain with MR angiogram intracranial vessels with contrast. Also, I suggest you exclude other mimics of such kind of scalp tenderness or headache.