Painful Scalp Lumps: When to Seek Medical Help

Lump on the scalp?

Hello Dr.
Li: About eight months ago, I discovered a lump on the top of my head that was painful when pressed.
In the past two to three months, I have noticed several more lumps (in a row) that are also painful when pressed, but they are more painful than before.
In June, I visited a neurologist, and an X-ray showed no abnormalities.
The doctor prescribed muscle relaxants and analgesics, but there was no improvement.
I then tried acupuncture with a traditional Chinese medicine practitioner three times, but there has been no improvement; in fact, I often experience headaches at night that are painful even without pressure.
It feels like a dull pain with a sense of pressure.
Dr.
Li, which specialty should I consult?

Xiao Hua, 30~39 year old female. Ask Date: 2018/09/08

Dr. Li Qinglong reply Surgery

Dear Miss Hsiao-Hua,
Your medical history is quite unique.
In surgery, physical examination is crucial, and without examining the mass, I truly cannot answer your questions.
I recommend that you visit the surgical outpatient clinic to assess the condition of the mass.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2018/09/08

More Info

When it comes to painful scalp lumps, it’s essential to approach the situation with a comprehensive understanding of potential causes and appropriate medical responses. Based on your description, you have experienced painful lumps on your scalp for several months, which have increased in number and intensity. Despite consulting a neurologist and trying muscle relaxants and acupuncture, you have not found relief, and you are now experiencing persistent headaches.

First and foremost, it’s important to recognize that scalp lumps can arise from various conditions, including but not limited to cysts, lipomas, infections, or even more serious issues such as tumors. The pain associated with these lumps can be due to inflammation, pressure on surrounding tissues, or nerve involvement. Given that you have already undergone imaging (X-ray) with no abnormalities noted, it may be time to consider further evaluation.

Here are some steps and considerations for seeking medical help:
1. Consult a Dermatologist: Since your symptoms are localized to the scalp, a dermatologist would be an appropriate specialist to evaluate the lumps. They can perform a thorough examination and may recommend a biopsy if there is any concern about the nature of the lumps. Dermatologists are skilled in diagnosing skin-related issues, including cysts, infections, and other dermatological conditions that may manifest as lumps.

2. Consider a Neurologist or Pain Specialist: If the lumps are not the primary issue but rather a symptom of a broader neurological problem, a neurologist may be able to provide further insights. Additionally, a pain specialist can help manage your headaches and any associated pain more effectively, especially if they are chronic.

3. Imaging Studies: If the lumps are concerning, your doctor may recommend further imaging studies, such as an MRI or CT scan, to get a clearer picture of what is happening beneath the surface. This can help rule out any underlying conditions that may not be visible on an X-ray.

4. Pain Management: Since you mentioned that you are experiencing headaches that are not alleviated by the medications prescribed, discussing alternative pain management strategies with your healthcare provider is crucial. This may include different classes of medications, physical therapy, or other interventions.

5. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any triggers you notice. This information can be invaluable to your healthcare provider in diagnosing and treating your condition.

6. Seek a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another neurologist or a different specialist can provide new insights or treatment options.

In summary, given the persistence and worsening of your symptoms, it is advisable to consult a dermatologist for a thorough evaluation of the scalp lumps. Additionally, consider revisiting a neurologist or a pain specialist to address your headaches and explore more effective pain management strategies. Your health and comfort are paramount, and finding the right specialist can make a significant difference in your treatment journey.

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