Why Does My Scalp Hurt? Understanding Trichodynia in Hair Loss

Most people with hair loss know that hair loss can hurt emotionally.

But what about when hair loss hurts physically?

Over the last few years, I’ve heard people describe their scalp pain in all sorts of ways.

“It feels like it’s burning.”

“My scalp feels like it’s on fire.”

“I can’t put any products on my scalp at all.”

“Sometimes I can’t even wash my hair because touching it hurts so much.”

“I’ve gone grey, but I can’t colour the little bit of hair I have left at the front because my scalp is so sore.”

If you’ve experienced something similar, you’re not alone.

Hair loss can sometimes be physically painful as well as emotionally distressing.

Doctors call this trichodynia. It’s just the medical term for scalp pain associated with hair loss.

Although it isn’t talked about very often, it can have a surprisingly large impact on day-to-day life.

A painful scalp isn’t a diagnosis

When someone tells me their scalp or hair hurts, I don’t immediately think about treatment.

I start asking questions.

Can you tell me more?

What does it actually feel like?

Is it burning, stinging or tender?

Is it there all the time, or does it come and go?

When did it first start?

Does anything seem to trigger it?

What makes it worse?

Does anything relieve it?

Have you already tried any treatments?

The answers matter because scalp pain isn’t a diagnosis.

It’s a symptom.

At that point, my next priority is to understand why your scalp hurts. That means identifying the underlying type of hair loss, because treating the cause often improves the pain too. This usually involves working alongside a dermatologist.

Why does trichodynia happen?

The honest answer is that we don’t yet fully understand why trichodynia happens.

It’s likely that different mechanisms are responsible in different types of hair loss.

In some people, inflammation around the hair follicles may irritate the tiny nerves within the scalp. In others, the nerves themselves may become more sensitive.

One of the things I find fascinating about hair loss is that the same symptom can mean completely different things in different people.

That’s why identifying the underlying type of hair loss is so important.

Which types of hair loss can cause it?

Trichodynia has been reported in several different forms of alopecia, including:

• Frontal fibrosing alopecia

• Lichen planopilaris

• Fibrosing alopecia in a pattern distribution

• Female pattern hair loss

• Chronic telogen effluvium

Not everyone with these conditions develops scalp pain, but when they do, it can sometimes become one of the symptoms that affects them most.

Does a painful scalp mean my hair loss is active?

Sometimes.

Particularly in inflammatory scarring alopecias such as frontal fibrosing alopecia and lichen planopilaris, scalp pain may suggest that inflammation is still active.

But not always.

That’s why scalp pain should never be looked at in isolation. It needs to be considered alongside your history, examination and, where appropriate, trichoscopy.

So what can be done?

Treatment depends on the underlying cause.

For example, in inflammatory scarring alopecias such as frontal fibrosing alopecia and lichen planopilaris, the first priority is usually to control the inflammation driving the disease.

If the inflammation settles, the scalp pain may settle too.

Other types of hair loss require different approaches.

Unfortunately, this doesn’t always happen.

Some people continue to experience burning, tenderness or pain despite receiving appropriate treatment for their underlying condition.

That naturally raises another question.

What can we offer those patients?

A study that caught my attention

A paper published in June 2026 explored exactly this question.

Researchers treated 21 patients with trichodynia associated with different forms of alopecia using botulinum toxin injections into the scalp.

These weren’t patients receiving botulinum toxin as a first treatment.

Most had already tried conventional therapies, or they couldn’t tolerate them, and their scalp pain remained a significant problem.

Around nine out of ten patients reported an improvement in their symptoms, usually within about three weeks. The greatest improvements were seen in patients with inflammatory scarring alopecias such as frontal fibrosing alopecia and lichen planopilaris.

Why did this paper interest me?

The papers I enjoy reading most aren’t always the ones with the biggest breakthroughs.

They’re the ones that make me think differently.

This paper did exactly that.

One thing you might expect me to say at this point is that I was surprised by these findings.

But I wasn’t.

Not because I’d seen botulinum toxin used for trichodynia before—I hadn’t.

But because botulinum toxin has already shown that it can help some people with other painful conditions where conventional treatments don’t always work or aren’t well tolerated.

The first condition that came to my mind was trigeminal neuralgia.

Trigeminal neuralgia is a completely different condition, but it causes severe facial pain and is sometimes described as one of the most painful conditions in medicine. While medications remain the mainstay of treatment, botulinum toxin has been investigated as another option for some people whose symptoms continue despite standard treatment or who cannot tolerate those medicines.

So when I read this paper, it didn’t feel completely unexpected.

It made me wonder whether this might be another example of botulinum toxin helping to calm abnormal pain signalling in carefully selected patients.

Whether that turns out to be true remains to be seen, but I found it an interesting line of research.

A word of caution

It’s important to keep this study in perspective.

Botulinum toxin is not a first-line treatment for trichodynia.

The first priority is always to understand why your scalp hurts and to treat the underlying hair loss appropriately.

This study looked at people whose symptoms had persisted despite conventional treatment, or who couldn’t continue those treatments.

For those patients, this research raises the possibility that botulinum toxin could become another option in the future.

This was a relatively small study involving just 21 patients, so much larger studies are still needed before we know exactly which patients are most likely to benefit.

My thoughts

One of the things I hope we’ll see over the next few years is more research into symptoms like scalp pain.

We shouldn’t judge success only by how many hairs someone grows.

Sometimes making someone’s scalp comfortable enough that they can wash their hair without pain, colour it again, or simply stop thinking about it every day can make a real difference to their quality of life.

Hair loss isn’t just about hair.

It’s about confidence, comfort and quality of life.

If your scalp hurts, don’t dismiss it or assume it’s simply something you have to live with.

Tell the clinician looking after you.

It may be an important clue to what’s happening beneath the surface.

And if conventional treatments haven’t been enough, studies like this suggest researchers are beginning to explore new possibilities.

That’s why this paper caught my attention. Not because it gives us all the answers, but because it asks an important new question.

At Growth Factor Hair Clinic, Professor Ryan Moseley and I are committed to translating complex hair research into clear, balanced information that helps people understand their condition. As new research is published, we’ll continue sharing not only what scientists have discovered, but why we think it matters—and just as importantly, where the unanswered questions still remain.

Saceda-Corralo D, Imbernon-Moya A, Jiménez-Cauhe J, Pindado-Ortega C, Balaguera-Orjuela V, Burgos-Blasco P, Guillem A, Gil-Redondo R, Vañó-Galván S. Effectiveness of Botulinum Toxin Type A for Trichodynia Associated with Hair Loss Disorders: A Retrospective Study. Dermatology and Therapy (Heidelberg). 2026. doi:10.1007/s13555-026-01820-z.