What Causes It? | Management | Support

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 is what you need to know about scalp discomfort in MS, including what causes it and how it can be managed.

What Causes Scalp Pain, Itchiness, and Numbness in MS?

There are several reasons for pain, itching, or numbness of the scalp with MS. According to a study of 428 people with MS, 12 percent of participants reported experiencing 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 to blame for scalp pain in people with MS.

Neuropathic pain affects as many as one-quarter of people with MS, and it can impact many different parts of the body. It typically occurs because of demyelination — MS-related damage to the protective coating (myelin sheath) of the nerves in the brain and spinal cord (the central nervous system, or CNS). This causes lesions to form on the nerves along the CNS. The lesions interfere with the nerves’ ability to transmit signals to the brain. This short-circuiting results in stabbing, burning, pins-and-needles, or squeezing sensations.

Nerve pain in MS may cause either chronic (long-lasting) or acute (short-lived) pain. Acute neuropathic pain may be one of the first symptoms of MS. It can also occur during an MS relapse (flare). Sometimes, nerve pain can last seconds to a few minutes, but it may keep reoccurring. This pattern is called paroxysmal nerve pain.

Scalp Itching

Although rare, one of the altered sensations some people with MS experience is pruritus (itching). This itching sensation is a type of sensory abnormality known as cutaneous dysesthesia.

“Cutaneous” refers to the skin. Cutaneous dysesthesia is commonly associated with neurological (nerve) diseases, including MS. It is a type of neuropathic pain. In addition to itching, cutaneous dysesthesia can cause stinging and burning sensations.

Although itching from cutaneous dysesthesia is felt in the skin, it is not caused by skin problems like allergies, irritation, or a rash. Instead, this sensation results from nerve damage caused by demyelination in MS.

As with MS-related pain, this itching occurs when the brain is unable to interpret the nerve signals it’s receiving. To make up for this, the brain relates these signals to a sensation it has already experienced, like itching.

As several members have reported, 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

Nearly 30,000 MyMSTeam members report experiencing numbness as a symptom of MS. There are several types of numbness seen in MS, including dysesthesia. Other types of numbness that may affect the scalp include:

• Paresthesia — Abnormal sensations like pins and needles, buzzing, prickling, crawling, or 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. This symptom also tends to repeatedly go away and return 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.

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, resulting in patches of scaly skin (plaques). Scalp psoriasis, in particular, may cause the scalp to itch, burn, or sting.

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

Managing Scalp Discomfort With MS

There are several ways that pain, itching, or numbness of the scalp may be treated in MS. The type of treatment your neurology team recommends will depend on the cause of your symptoms.

Treating Scalp Pain

If scalp pain is caused by nerve problems, your neurologist may prescribe medications for neuropathic pain, including gabapentin (Neurontin), pregabalin (Lyrica), or duloxetine (Cymbalta).

Treating Scalp Itching

If your scalp is itchy, your doctor will first determine whether neuropathic problems or a skin condition is the cause. Dry, red, 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 will not be effective. Instead, your doctor may prescribe anti-seizure 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.

Treating 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 cannot be treated with medications. It is usually painless and may resolve on its own.

If you experience severe or widespread numbness from an MS flare-up (relapse), your doctor may prescribe anti-inflammatory medications like corticosteroids to help you recover more quickly. As with itching, numbness accompanied by burning or painful sensations may be treated with anticonvulsants or certain antidepressants, including imipramine or nortriptyline.

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

Are you or a loved one living with multiple sclerosis? Consider joining MyMSTeam today. Here, members from around the world come together to share their stories, ask questions, offer support and advice, and more. You can connect with more than 185,000 members worldwide who understand life with MS.

Have you experienced scalp pain, itching, or numbness with MS? How have you managed it? Share your story or tips in the comments below or by posting on MyMSTeam.