look up information on "trichodynia" or "burning scalp syndrome".
the bottom line is extreme stress/anxiety/obsession with your hair has led to psychogenic scalp pain due to excess substance p release. substance p release and subsequent mast cell degranulation has been experimentally linked to stress-related hair loss. the same process can contribute to the itching that so many experience, and, if the stress is bad enough, the process can lead to a greater degree of local inflammation and the accompanying tenderness.
here's some of the stuff you'll find on just trichodynia. there are several other studies that I'm not posting that specifically address substance p/NGF/mast cells and hair loss:
Int J Dermatol. 2003 Sep;42(9):691-3. Related Articles, Links
The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia.
Kivanc-Altunay I, Savas C, Gokdemir G, Koslu A, Ayaydin EB.
Department of Dermatology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.
[email protected]
BACKGROUND: Trichodynia refers to pain, discomfort, and/or paresthesia in the skin of the scalp or the hair. There may be an associated psychologic comorbidity. Although androgenetic alopecia (Androgenetic Alopecia) and telogen effluvium (Telogen Effluvium) are different entities in terms of pathogenesis, etiology, and clinical picture, both may be influenced by psychologic stress and may be the cause of secondary stress. AIMS: To investigate the presence of trichodynia in patients with Telogen Effluvium and Androgenetic Alopecia and to evaluate psychologic comorbidity in patients with trichodynia. MATERIALS AND METHODS: A total of 248 patients (153 females, 95 males), presenting with hair loss due to either Telogen Effluvium or Androgenetic Alopecia, were enrolled in this study. The prevalence of trichodynia in these two groups was compared with that in controls (n = 184). In addition, psychiatric evaluation was performed in 25 patients with trichodynia (13 females, 12 males) and in 25 controls (16 females, nine males) without alopecia and trichodynia by a psychiatrist; Diagnostic and Statistical Manual of Mental Disorders (DSM)IV criteria were used for the assessment. RESULTS: Trichodynia was found in 72 patients (29%) with hair loss and in six controls (3.3%; P < 0.0001); 25 of the 72 patients with trichodynia underwent psychiatric evaluation and 19 of the 25 patients were found to have psychopathologic signs (76%). In the control group, only five patients had psychopathologic signs (20%; P = 0.0004). Of those with hair loss, trichodynia was more frequent in the Telogen Effluvium group than in the Androgenetic Alopecia group (P < 0.0071). CONCLUSIONS: Trichodynia is a common symptom in patients with Telogen Effluvium and Androgenetic Alopecia, and often coexists with psychopathologic findings, including depression, obsessive personality disorder, and anxiety.
Arch Dermatol. 1998 Mar;134(3):327-30.
Scalp dysesthesia.
Hoss D, Segal S.
Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome. OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms. Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride. One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse. CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
Dermatology. 2002;205(4):374-7.
Hair pain (trichodynia): frequency and relationship to hair loss and patient gender.
Willimann B, Trueb RM.
Department of Dermatology, University Hospital of Zurich, Switzerland.
BACKGROUND: Patients complaining of hair loss frequently claim that their hair has become painful. OBJECTIVE AND METHODS: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. RESULTS: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. CONCLUSIONS: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual. Copyright 2002 S. Karger AG, Basel