People with multiple sclerosis (MS) may experience abnormal sensations, including pain, burning, itching, or numbness. For some, these sensations affect the scalp and cause discomfort.

“Has anyone ever experienced a tender scalp?” asked one MyMSTeam member. “My scalp is so sensitive now. Been this way for about three months now.”

Other members have had similar sensations, often lasting for long periods of time. One wrote that their scalp “has been burning/itching for eight weeks now with no redness or rash,” while another reported having “an itchy scalp for over two years.”

A painful, itchy, or numb scalp can be frustrating — especially if there is no visible rash or skin irritation. Here’s what you need to know about scalp discomfort in MS, including its causes and how it can be managed.

Possible Causes of Scalp Symptoms in MS

There are several reasons for pain, itching, or numbness of the scalp in people with MS. In a study of 428 people with MS, 12 percent of participants reported experiencing dysaesthesia (painful altered sensations) at some point in their lives. Some of these sensations — particularly nerve pain, itching, and numbness — may affect the skin, including the scalp.

Scalp Pain

“My scalp on one side hurts so badly and is sore,” wrote one MyMSTeam member. “Anyone know if this is due to MS?”

There are two main types of pain in MS: neuropathic (nerve) pain and nociceptive (musculoskeletal) pain. Nerve pain — the most common type of pain in MS — may be the cause of scalp pain.

Neuropathic pain affects up to one-quarter of people with MS and can impact various parts of the body. This pain is often linked to demyelination, which is MS-related damage to the myelin sheath — the protective coating of the nerves in the central nervous system (CNS), including the brain and spinal cord. As a result, lesions (areas of damage) form on the nerves, disrupting their ability to transmit signals to the brain. This “short-circuiting” can cause stabbing, burning, pins-and-needles, or squeezing sensations.

Nerve pain in MS may be either chronic (long-lasting) or acute (short-lived). Acute neuropathic pain may be one of the first symptoms of multiple sclerosis. It can also occur during an MS relapse. It may last seconds to a few minutes but can recur frequently. This pattern is known as paroxysmal nerve pain.

Scalp Itching

Though rare, some people with MS experience pruritus (itching), a type of sensory abnormality known as cutaneous dysesthesia. “Cutaneous” refers to the skin, and cutaneous dysesthesia is a type of neuropathic pain. In addition to causing itching, cutaneous dysesthesia can lead to burning, or stinging sensations on the skin, including the scalp.

Itching caused by cutaneous dysesthesia is not due to skin problems like allergies, irritation, or a rash. Instead, this sensation results from nerve damage caused by demyelination in MS.

Similar to MS-related pain, itching occurs when the brain misinterprets nerve signals. The brain assigns a familiar sensation, like itching, to the signal.

As several members have noted, this itching can affect the scalp and sometimes include other sensations. “My scalp is itching and burning today,” wrote one member. “I feel like bugs are crawling up around there. I am going insane.”

Scalp Numbness

More than 32,000 MyMSTeam members report experiencing numbness as a symptom of MS. Several types of numbness are seen in MS, including dysesthesia and the following:

• Paresthesia — Abnormal sensations like pins and needles, buzzing, prickling, crawling, or scalp tingling
• Anesthesia — A total lack of sensation, including pain, touch, or temperature (very rare in MS)

Numbness, like pain and abnormal sensations, typically results from nerve problems due to demyelination. In some cases, numbness may be one of the first MS symptoms a person experiences, and it can come and go over time.

Other Possible Causes of Scalp Discomfort

In some cases, you may experience scalp pain, itching, or numbness as a result of another condition unrelated to MS. Psoriasis, for instance, tends to affect people with MS at higher rates than the general population.

Disease-Modifying Therapies

Some disease-modifying therapies (DMTs) for MS can cause itching and pain. Some DMTs are delivered by intravenous (IV) infusion. Itching is a common infusion side effect. However, DMTs that are administered by an injection (shot under the skin) or by pill may also cause skin symptoms.

If you think your DMT is causing scalp-related side effects, talk to your doctor. They can recommend ways to manage scalp itching, numbness, or burning.

Psoriasis

Psoriasis, like MS, is an autoimmune disorder: It occurs when the body’s immune system mistakenly attacks its own healthy cells. This skin condition causes skin cells to build more quickly than they are shed, forming plaques (patches of scaly skin). Scalp psoriasis, in particular, may cause the scalp to itch, burn, or sting. If you have both scalp psoriasis and MS, the itching may be more intense, affecting your head, neck, and the area behind your ears.

Skin Allergies

People with MS may also develop allergy-related conditions of the skin like urticaria (hives) or eczema, both of which can cause itching.

Managing Scalp Discomfort With MS

Scalp pain, itching, or numbness can be treated in various ways. The treatment your neurologist recommends will depend on the underlying cause of your symptoms.

Treating Scalp Pain

If scalp pain is caused by nerve problems, your neurologist may prescribe medications for neuropathic pain, including:

• Duloxetine (Cymbalta)
• Gabapentin (Neurontin)
• Pregabalin (Lyrica)

Treating Scalp Itching

If your scalp is itchy, your doctor will first determine whether neuropathic problems or a skin condition is the cause. Dry, discolored, inflamed, or scaly skin may indicate a condition like scalp psoriasis. Nerve pain will not cause visible changes to the scalp.

If your itching is caused by cutaneous dysesthesia, topical treatments or creams like corticosteroids and antihistamines won’t be effective. Instead, your doctor may prescribe antiseizure medications (anticonvulsants) such as gabapentin, carbamazepine, and phenytoin. Certain antidepressant medications may also be used to treat dysesthetic itching. Hydroxyzine, an anti-itch medication, can also be effective. It’s important to weigh the benefits and risks before starting any medications, as they can have significant side effects.

In some cases, nerve-related itching may resolve without treatment. It may also go away and return. Placing a cloth-covered ice pack onto the skin may help numb the itching sensation.

Scalp Itching Caused by Skin Conditions

If your scalp is itchy due to a condition like psoriasis, hives, or eczema, your neurologist may refer you to a dermatologist. This specialist can work with you to find the right treatment for your condition. Scalp psoriasis and scalp eczema may be treated with topical corticosteroids or medicated shampoos. Hives may be treated with over-the-counter allergy medications or other oral or intravenous (IV) drugs.

Treating Scalp Numbness

According to the National Multiple Sclerosis Society, numbness is usually painless and may resolve on its own.

If you experience severe or widespread numbness from an MS relapse, your doctor may prescribe anti-inflammatory medications like corticosteroids to help you recover more quickly. As with itching, numbness accompanied by painful sensations may be treated with anticonvulsants or certain antidepressants, including imipramine or nortriptyline. If you’re trying to stop the burning sensation on your scalp, these treatments may also be effective to ease that symptom.

When To Talk to Your Doctor

No matter which scalp symptoms you experience, talk to your neurologist or other health care provider to see how to manage scalp discomfort. They will be able to determine the underlying cause and work with you to find treatments to help maintain your quality of life.

Find Your Team

On MyMSTeam, the social network for people living with multiple sclerosis and their loved ones, more than 215,000 members come together to share their stories, ask questions, offer support and advice, and more.

Have you experienced scalp pain, itching, or numbness with MS? Have you found any effective ways to manage these symptoms? Share your story or tips in the comments below or by posting to your Activities feed.