Finding a lump on the top of your head that causes pain when pressed can be concerning. While the scalp is a common site for various growths, and most are not serious, pain often indicates inflammation, infection, or pressure on surrounding tissues. Understanding the lump’s specific characteristics and any accompanying symptoms is the first step in determining the cause. This cause can range from minor skin conditions to the body’s response to an injury.
Common Causes of Painful Scalp Lumps
A frequent cause of a painful lump is a minor injury resulting in a localized collection of blood, known as a scalp hematoma. Trauma, even from a simple bump, leads to bleeding beneath the skin, causing swelling and tenderness. These lumps are often soft and may be accompanied by bruising. The pain typically subsides as the body reabsorbs the blood and the injury heals over a few days.
Many painful lumps originate from the skin’s structures, specifically the hair follicles and glands. Folliculitis, an infection of the hair follicle, appears as a red, pus-filled bump that is sore to the touch, similar to acne. An ingrown hair, where the hair curls back into the skin, can also trigger a localized inflammatory response, resulting in a painful, infected bump.
Cysts are common, usually benign findings on the scalp that become painful when pressed if they become infected or inflamed. Epidermoid cysts contain keratin buildup, while pilar cysts arise from the hair root sheath; both are typically slow-growing and movable. If these cysts rupture or become infected with bacteria, they can swell rapidly and cause significant pain. Lipomas, which are soft, fatty deposits under the skin, are generally painless but may cause discomfort if they grow large enough to press on surrounding nerves or tissue.
Characteristics That Warrant Urgent Medical Attention
While most scalp lumps are benign, certain features signal a need for immediate medical evaluation. These “red flags” include rapid growth, such as doubling in size over a few weeks or months. Concern is also warranted if a lump appears hard, fixed, and immovable when pressed. Since benign cysts are typically soft and movable, a firm, non-mobile mass may indicate involvement of deeper tissues or bone.
The presence of accompanying systemic symptoms raises suspicion for a more serious underlying condition. These include unexplained fever, drenching night sweats, or significant, unintentional weight loss. Additionally, a lump that has an open sore, bleeds spontaneously, or develops an ulceration that fails to heal within a few weeks should be evaluated promptly.
Neurological symptoms occurring alongside a new or changing lump require urgent care. These may include sudden or severe headaches, changes in vision, persistent dizziness, confusion, or weakness in the limbs. Such symptoms suggest a problem affecting the central nervous system or structures inside the skull, requiring immediate diagnostic imaging. Swollen lymph nodes in the neck or around the ear, occurring concurrently with the scalp lump, can also signal infection or, less commonly, the spread of malignancy.
Medical Diagnosis and Management
When a patient presents with a painful scalp lump, the medical professional begins with a detailed history. They ask about the lump’s duration, growth speed, and whether any injury preceded its appearance. A thorough physical examination involves palpating the mass to assess its size, texture, mobility, and tenderness. This helps determine if the mass is solid or fluid-filled and its approximate depth beneath the skin.
If the lump’s nature is unclear after the initial assessment, diagnostic imaging is often required. High-frequency ultrasound is the preferred initial tool for superficial lesions, as it distinguishes between a fluid-filled sac (like a cyst or abscess) and a solid mass (like a lipoma or tumor). For masses suspected to involve underlying bone or brain tissue, a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) provides superior detail of the deeper structures.
Definitive diagnosis, especially if malignancy is suspected, requires a histopathological assessment through a biopsy. This procedure involves surgically removing a small sample or the entire mass for microscopic examination to identify the exact cell type. Treatment is tailored to the diagnosis; minor infections or small, uninfected cysts may be managed conservatively with warm compresses and observation. Abscesses are typically treated with incision and drainage to release the collected pus. Symptomatic or suspicious solid masses, including confirmed malignancy, are usually treated with surgical excision.