A lump on the top of the head that causes pain when pressed can be alarming, but this symptom often points toward common, non-life-threatening conditions. The pain is typically a result of inflammation, swelling, or pressure exerted on the sensitive tissue of the scalp. This information is not a substitute for a professional medical evaluation, which is necessary for an accurate diagnosis and appropriate care.
Common Causes Originating in the Scalp and Skin
The majority of painful lumps on the scalp arise from the superficial layers, specifically the skin and hair follicles, and are frequently benign growths or infections. The sensation of pain when pressing these lumps generally indicates an inflammatory response within the tissue.
One of the most frequent causes is a sebaceous cyst, often referred to as a pilar cyst when it occurs on the scalp. These are noncancerous, closed sacs that form beneath the skin, filled with keratin. While typically painless, a sebaceous cyst becomes tender or painful when it is infected or inflamed, often due to physical irritation or bacterial invasion. Pressing on an inflamed cyst increases the internal pressure and irritation on the surrounding tissue, causing discomfort.
Another common type of growth is a lipoma, which is a benign tumor composed of fatty tissue situated just under the skin. These growths usually feel soft and rubbery and are often mobile when pressed. Lipomas on the head are uncommon compared to other body areas, but when they do occur, they are generally painless unless they grow large enough to press on surrounding nerves or become inflamed.
Inflammation or infection of the hair follicles, known as folliculitis, can create small, painful bumps that resemble pimples. Folliculitis occurs when bacteria or fungus infect the hair root, leading to localized redness, swelling, and tenderness.
A localized abscess or boil is a deeper form of skin infection that results in a pus-filled, warm, and tender lump due to the body’s immune response. An ingrown hair, which occurs when a hair curls back into the skin, can similarly cause a small, inflamed bump that is sensitive to pressure.
Causes Related to Underlying Bone or Injury
When a lump is deeper, it may originate from structures beneath the skin layer, often involving trauma or the bone itself. These causes are distinct from superficial skin issues because they involve different tissue layers.
A common cause following a blow or bump to the head is a hematoma, a collection of blood that pools outside of a blood vessel. On the scalp, a hematoma forms when blood vessels are damaged, causing localized swelling and a tender “goose egg” bump. The pain relates directly to the pressure of the pooled blood and the resulting inflammation. These lumps are associated with a recent instance of trauma.
In contrast, an osteoma is a benign, slow-growing outgrowth of bone tissue that forms on the skull. Unlike soft tissue masses, an osteoma is characteristically hard and fixed in place. While often asymptomatic, an osteoma may cause a dull ache or become painful when pressed, especially if it irritates the periosteum, the nerve-rich membrane covering the bone.
Immediate Warning Signs Requiring Medical Attention
While many painful lumps are benign, certain associated symptoms indicate a need for immediate medical evaluation to rule out more serious conditions.
Rapid growth of the lump over a short period should be a cause for concern, as should any lump that feels hard and immobile, suggesting it is fixed to deeper structures like the skull. Signs of a severe localized infection require immediate attention, including a lump that is excessively warm, intensely red, or draining foul-smelling pus or discharge.
Systemic symptoms accompanying the lump are particularly concerning and warrant an emergency room visit. These include a high fever or chills, which suggest a widespread infection, or any neurological changes. Symptoms that must be evaluated immediately include:
- Severe, persistent headache
- Confusion
- Vision changes
- Slurred speech
- Sudden dizziness or loss of consciousness following an injury
Medical Evaluation and Treatment Options
A healthcare provider will typically begin the evaluation with a detailed physical examination, assessing the lump’s size, consistency, mobility, and tenderness. They will ask about the lump’s history, including its growth rate and any preceding trauma, to narrow down the potential cause.
To determine the nature of the lump beneath the skin, specific imaging tools may be employed. An ultrasound is often the initial choice for soft tissue masses, differentiating between a fluid-filled cyst, a solid lipoma, or a hematoma. If the lump is hard or fixed, an X-ray or a Computed Tomography (CT) scan may be ordered to assess the underlying bone for an osteoma or other abnormality. If malignancy is suspected, a biopsy may be performed to analyze a small tissue sample.
Treatment is tailored to the specific diagnosis. For infected cysts or abscesses, the primary treatment involves oral or topical antibiotics to clear the infection, and sometimes incision and drainage to relieve pressure and remove the accumulated fluid or pus. Small hematomas are generally managed with observation and typically resolve on their own as the body reabsorbs the blood. Cysts, lipomas, or osteomas that are persistently painful, large, or cosmetically bothersome are often treated with surgical excision to completely remove the mass and prevent recurrence.