Kindly explain the reason for my scalp tenderness.

Hello,

Welcome to icliniq.com.

Thanks for giving such 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 other causes of scalp tenderness, in your case, with a background history of migraine, it seems to be the cause.

If migraine headache is very frequent, then it gets converted into a chronic daily headache, or if frequent analgesics are used, it can convert into medication overuse headache. Pregabalin can cause some sedation. But, if started in low dosage and gradually increased, then sedation either does not occur or if it occurs, lasts for three to five days only.

Gabapentin is a good alternative to Pregabalin, which causes very minimal sedation. Left leg numbness can be meralgia paresthetica (numbness or pain in the outer thigh due to nerve injury), but it needs investigation for that. The probable cause is poorly treated migraine or irregular treatment. Investigations to be done are:

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

2. Magnetic resonance imaging (MRI) of the brain and MR angiogram of the 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.

The differential diagnosis includes:

1. Migraine headache leading to chronic daily headache.

2. Giant-cell arteritis (temporal arteritis).

3. Insomnia due to chronic daily headache.

The probable diagnosis is migraine headache. The treatment plan includes getting a 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 to be normal, then start appropriate prophylactic medications for migraine.

The preventive measures include:

1. Avoid trigger factors of migraine headache.

2. Do not wear a tight belt at the waist.

I hope I have addressed all your questions. If there is anything else, please let me know.

Thank you.

Hi,

Welcome back to icliniq.com.

Many times, migraine are waxing and waning in nature. The scalp tenderness and dull headache seem to be a type of migraine headache. If the previous magnetic resonance imaging (MRI) of the brain was done with contrast, you can skip the new MRI. But, if the previous one was without contrast, then I suggest you get another MRI brain with an MR angiogram of intracranial vessels with contrast. Also, I suggest you exclude other mimics of this kind of scalp tenderness or headache.

I hope I have addressed all your questions. If there is anything else, please let me know.

Thank you.