Q. Kindly explain the reason for my scalp tenderness.

Answered by
Dr. Hitesh Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 01, 2016 and last reviewed on: Jul 25, 2020

Hi doctor,

I am suffering from localized tenderness in scalp. I also have left thigh numbness. My doctor diagnosed it as mild meralgia paresthetica. He prescribed Pregabalin, but I did not take due to concern of dizziness and drowsiness. I always have a fear that antidepressant medicine can cause cancer in later stages of life. I have attached my medical history for your reference. Please help.

#

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 causes:

Poorly treated migraine or irregular treatment.

Investigations to be done:

1. Nerve conduction study of bilateral lower limbs, including bilateral lateral cutaneous nerve of thigh.
2. 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.

Differential diagnosis:

1. Migraine headache leading to chronic daily headache.
2. Giant-cell arteritis (temporal arteritis).
3. Insomnia due to chronic daily headache.

Probable diagnosis:

Migraine headache.

Treatment plan:

Get 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.

Preventive measures:

1. Avoid trigger factors of migraine headache.
2. Do not wear tight belt at waist.

Regarding follow up:

Revert back with the test reports to a neurologist online.---> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

The MRI was done for scalp and brain before two years, which was quite normal. I do not have a headache. I have pain under the skin of the scalp. My glucose level in fasting and random are 75 and 105 respectively. My CRP, homocysteine and all other body function test like liver function, kidney, heart, TMT and echo are normal. My cholesterol is 200 and vitamin B12 is 180. I had only one episode of migraine before six years, which was a throbbing headache. Then, two years ago, I had left-sided dull continuous pain on the scalp that eases after rest or sleep, but comes again.

#

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 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.

Revert back with the reports to a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist



Was this answer helpful?

 | 


Related Questions:
Is headache a side-effect of Nevanac ophthalmic suspension?

.. (Nepafenac) does not have such side effects. But, I suggest you reduce the frequency of Nevanac to twice daily after 15 days and then to once at bedtime after next 15 days. You said you are wearing -2.75 in the right and -3.75 in left. This is a ...   Read full

Does opiate withdrawal cause nausea, low BP, muscle pain and urea smell?

.. fine to stop Lyrica (Pregabalin). In my opinion, your symptoms could be related to a panic attack, probably caused by Topiramate adverse effects. Besides, as Topiramate can also cause kidney dysfunction. So, I strongly agree with your doctor on st...   Read full

MRI shows 'intermediate signal intensity lesion in endometrial cavity.' What is it?

.. report, there is a possibility of malignancy. Cancer of the uterus is more likely. Do CA 125 level, CT scan abdomen and pelvis, X-ray, sonography, PET scan and consult a gynecologist near you and also take an opinion from an oncosurgeon. Doctors...   Read full

Also Read Answers From:

Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers


MRI spine showed intramedullary mass at T4. Is it a cyst or malignancy?

Query: Hello doctor, I had an MRI of the thoracic spine and it showed an intramedullar mass at level T4. I was told it is likely to be a cyst and is not malignant. However, everything I have read online says that intramedullar lesions are almost always malignant and cysts are rare or maybe evidence of MS,...  Read Full »

Is my mother's leg pain sciatica or something else?

Query: Hello doctor, My 49 year old mother has a severe (sciatica-like) leg pain. There is also pain below the knee and at the back of the leg. The pain is an extreme burning sensation kind of pain. It sometimes moves to the hips. The pain increases when she sits or tries to walk. She is taking a pain ki...  Read Full »

Does the blood pressure medication could cause headaches?

Query: Hi doctor, I am a 50 year old female. I have aches in my limbs and thighs especially at night. It is often characterized by heaviness in limbs. I am getting headache chiefly in left side of the head. I am taking painkiller at least once in a week for the same. I am taking Newtel 40 mg for blood pres...  Read Full »

Also Read


Sinusitis - Causes, Symptoms and Treatment
Sinusitis is the infection of the air cavities within the nasal passages. Normally, the healthy sinuses are filled with ...  Read more»
Asthma and Its Rising Incidence
This article explains about asthma and its causes. It also focuses on the benefits of starting early treatment to lead a...  Read more»
Parkinson's Disease: Historical Aspects and Current Treatment Approaches
This article discusses the historical aspects of Parkinsonism and, the evidence based approaches currently available for...  Read more»

Ask your health query to a doctor online?

Ask a Neurologist Now

* guaranteed answer within 4 hours.

Disclaimer: All health Q&As content published on this website are not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.