A spot on the head that hurts when pressed, often described as localized tenderness or sharp pain upon touch, is a common symptom. This discomfort, provoked by external pressure or movement, suggests an issue lying close to the surface, whether in the skin, underlying muscle, or superficial nerves. While the head contains sensitive structures, the causes for this highly localized pain are frequently benign and originate in the tissues of the scalp itself. This article explores the most common non-emergency explanations for this hypersensitivity, ranging from superficial skin irritations to deeper muscular and nerve-related conditions.
Common Causes Originating in the Scalp
The most frequent explanations for a tender spot on the head are found within the skin, hair follicles, or the immediate layer beneath the surface. Minor trauma, such as a bump or pressure injury from tight headgear, can create a small, localized bruise or inflammation. This superficial injury involves a localized release of inflammatory chemicals, sensitizing pain receptors in that precise area of the scalp.
Folliculitis and Dermatitis
Inflammation of the hair follicles, known as folliculitis, is a common superficial source of tenderness. Folliculitis occurs when the follicle becomes irritated or infected, often by bacteria or fungi, resulting in small, red, or pus-filled bumps that are painful to the touch. Pressing on the spot directly irritates the swollen, infected tissue surrounding the hair root. Similarly, harsh hair products, dyes, or chronic tension from tight hairstyles can cause contact dermatitis, leading to localized inflammation and hypersensitivity of the scalp skin.
Cysts and Lumps
A lump or cyst beneath the scalp surface can also become acutely tender when pressure is applied. Pilar cysts, which are keratin-filled sacs, are particularly common on the scalp. Although usually painless, they become notably tender if they rupture, become inflamed, or get infected. The body’s immune response causes swelling and pain around the lesion, and pressing the spot compresses the inflamed tissue against the skull.
Pain from Muscle Tension and Trigger Points
Discomfort felt deep beneath the scalp surface, aggravated by touch, can often be traced back to the underlying musculature. Muscles covering the skull, such as the temporalis and those at the base of the neck, are highly susceptible to chronic tension. This sustained contraction can lead to the development of myofascial trigger points—hyperirritable spots in a taut band of muscle.
When pressure is applied to a trigger point, it elicits a strong localized pain response, sometimes accompanied by referred pain to another area of the head. For example, trigger points in the suboccipital muscles can refer pain felt as a spot of tenderness on the top or side of the head. This tenderness results from the mechanical compression of the tight muscle knot.
Tension headaches are closely linked to this muscular mechanism, as chronic stress or poor posture causes prolonged strain on the pericranial muscles. The resulting muscle tightness decreases blood flow, irritating the tissue and leading to discrete tender spots on the scalp. The pain is typically described as a deep, dull ache or a feeling of pressure.
Localized Nerve Irritation
A sharp, shooting, or electric sensation when a spot is pressed often points to irritation or inflammation of a superficial nerve. The scalp is extensively supplied by sensory nerves, including the greater and lesser occipital nerves, which run from the upper neck up the back of the head. When these nerves become compressed or inflamed, occipital neuralgia can occur, resulting in localized tenderness.
The pain of occipital neuralgia is characteristically sharp, jabbing, or shock-like, often starting at the base of the skull and radiating over the scalp. The sensation of pain upon light touch, known as allodynia, is a hallmark of nerve irritation. This means simple actions like brushing hair or resting the head on a pillow can trigger intense pain. Mechanical compression of the nerve as it passes through tight muscles or fascia is often the source of this hypersensitivity.
Other smaller nerves, like the supraorbital or supratrochlear nerves near the forehead, can also be affected by localized entrapment or injury. Trauma or chronic muscle tightness can pinch these nerve branches, leading to a small, isolated spot that is acutely painful when touched. The hypersensitivity results from the direct stimulation of an inflamed or compressed nerve pathway.
When to Seek Professional Medical Advice
While most instances of localized scalp tenderness are minor and self-limiting, certain accompanying signs suggest the need for prompt medical evaluation.
You should seek medical attention if the pain is persistent or worsening, or if it is associated with systemic signs of infection, such as fever, chills, or rapidly expanding redness and warmth. Any tenderness accompanied by a firm, non-mobile lump that is growing quickly also warrants professional assessment.
Immediate or emergency care is necessary if you experience:
- The “worst headache of your life,” or pain that comes on suddenly like a thunderclap.
- Pain following a significant head trauma.
- Neurological symptoms alongside the localized pain, such as sudden confusion, weakness, numbness on one side of the body, vision changes, or difficulty speaking.
- Tenderness over the temples, especially if accompanied by jaw pain while chewing or visual disturbances, which could indicate temporal arteritis.