Head / Face
Scalp Myofascial Pain
두피 근막통증
Diffuse scalp pain from trigger points and tenderness of occipitofrontalis and galea aponeurotica
- How common
- Common (underdiagnosed in chronic HA patients)
- Typical age
- Ages 20–60
What is it?
Combined cervicocranial muscle tension and galeal tightening create scalp trigger points and allodynia; peripheral and central sensitization drive chronicity.
Commonly affected: Occipitofrontalis, temporalis, galea aponeurotica
How it develops
- Muscle/Galea TighteningOccipitalis, frontalis, temporalis and galea co-contract
- Trigger Point FormationDiffuse tender scalp nodules
- Peripheral SensitizationScalp nerve endings become hypersensitive
- Central Sensitization/AllodyniaTrigeminocervical complex sustains hyperalgesia
Symptoms
- Diffuse scalp painNot localized to one region
- AllodyniaPainful with hat/brush/pillow
- Scalp trigger pointsLocalized tender nodules
- Associated headacheFrequently coexists with TTH
- Worse with stressWorse with stress/fatigue
How it is examined
- Scalp palpationIncreased galeal tension with multiple tender nodules
- TrP referralPressing occipitalis/temporalis reproduces pain
- Cervical ROMReduced upper cervical ROM and tenderness common
- Normal neurologic examCranial nerves, sensation, strength normal
Imaging
Clinical diagnosis; X-ray generally unnecessary.
- Usually normal
- Possible cervical postural change
- Normal osseous structures
MRI only for red flags; US useful for evaluating galea and myofascial trigger points.
- MRI usually normal
- US: hypoechoic nodules and taut bands
- No structural lesion
Non-surgical care
- Scalp/myofascial releaseManual or tool-assisted scalp release
- Heat/stretchingHeat and stretching of cervicocranial muscles
- TrP dry needling/injectionTargets active scalp TrPs
- Stress/sleep managementRelaxation, sleep hygiene, amitriptyline if needed
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
No surgical indication
Procedures that may be discussed
- Conservative care only
Outlook
Most improve in weeks-months with myofascial therapy and stress management.