FREE Shipping on all US Orders
Scalp pain at the hair root has a name — and a surprisingly specific set of causes. Here is what trichodynia actually is.
Scalp pain or tenderness at the hair root during shedding is called trichodynia. It affects approximately one-third of patients with hair loss disorders, is significantly more common in women, and is often dismissed as psychosomatic when there is a real, documented neurochemical and inflammatory mechanism. A January 2025 study found substance P tissue levels 5x higher in trichodynia patients. A June 2026 study found botulinum toxin relieved it in 9 of 10 resistant cases. Here is what is actually happening — and what helps.
Scalp pain isn't a diagnosis. It's a symptom. Where it is located, when it appears, and which other symptoms accompany it all offer diagnostic information. The pain at the hair root during active shedding is not imagined — it has a measurable neurochemical substrate in elevated substance P and perifollicular inflammation. It is telling you something specific about what is happening in the follicle.
In brief: If your scalp feels tender, sore, or burning — especially around the hair roots during periods of active shedding — you may have trichodynia. It affects approximately one-third of people with hair loss disorders, is significantly more common in women, and has a documented neurochemical and inflammatory mechanism. It is not imagined. A January 2025 study found substance P tissue levels five times higher in trichodynia patients than in healthy controls. And it is telling you something specific about what is happening in your follicles.
Most people who experience scalp pain during hair loss are told one of two things: that it is stress, or that it is not a recognised symptom and therefore probably psychosomatic. Trichodynia is a scalp condition characterized by discomfort, pain, or tenderness, often without visible inflammation or lesions. It is not a standalone disease but often a symptom linked to other medical or psychological conditions.
That last sentence is important — trichodynia is a symptom, not a diagnosis in itself. Where the pain is located, when it appears, and which other symptoms accompany it all offer diagnostic information about the underlying condition. A 2025 study published in the Journal of Drugs in Dermatology (Desir et al., Weill Cornell Medical College and University of Pennsylvania) confirmed that scalp pain or tenderness location can offer diagnostic clues about which type of scarring alopecia a patient has — meaning the symptom you might dismiss as stress is actually clinically informative.
What is trichodynia and how common is it?
In a study that assessed 249 patients for the presence of trichodynia, 35.7% were found to have been experiencing the syndrome alongside other hair loss conditions. The condition was more common in females than males.
Trichodynia — also called burning scalp syndrome or scalp dysesthesia — describes pain, burning, stinging, or tenderness at the scalp and hair roots, particularly when touching or combing the hair. It can be continuous or intermittent. It often worsens during periods of active shedding. And despite affecting more than a third of people with hair loss conditions, it is rarely discussed in consultations, rarely documented in medical notes, and rarely treated as a symptom with its own clinical significance.
Approximately one-third of patients with trichological disorders experience sensitive scalp symptoms. Telogen effluvium is strongly associated with scalp tenderness, pain, burning sensation, and pruritus — with significantly higher prevalence of sensitive scalp compared to other alopecia types. Alopecia areata patients also report significantly elevated rates of pruritus and trichodynia.
What causes scalp pain at the hair root?
The mechanism is now better understood than it was five years ago. Research points to two overlapping processes: neurogenic inflammation and perifollicular inflammation, both involving the neuropeptide substance P.
A case-control study published in the Journal of the Egyptian Women's Dermatologic Society in January 2025 (Gohary et al.) enrolled 35 trichodynia AGA patients and 35 healthy controls and measured tissue and serum levels of substance P. The mean tissue levels of substance P were significantly higher in patients (448.11 ± 241.24 pg/g) than in controls (75.78 ± 11.81 pg/g) — a nearly sixfold difference (p<0.0001). Serum levels were also significantly higher in patients than controls (325.09 ± 218.43 vs 171.06 ± 42.19 pg/mL, p=0.0002). The study concluded that substance P accompanied by perifollicular inflammation plays a major role in the pathogenesis of trichodynia.
Substance P is a neuropeptide released by sensory nerve endings in the skin. It amplifies pain signals, promotes local inflammation, and contributes to the sensitisation of nerve endings so that normally non-painful stimuli — like the weight of your hair, or brushing — become uncomfortable. The pain at the hair root is not imagined. It has a measurable neurochemical substrate in elevated substance P and the perifollicular inflammatory environment that this series has covered extensively.
What conditions cause scalp pain during hair loss?
Telogen effluvium is strongly associated with scalp tenderness, pain, burning sensation, and pruritus, with significantly higher prevalence of sensitive scalp compared to other alopecia types. During active TE, large numbers of follicles transition simultaneously into telogen — and the physical process of the follicle entering the resting phase, combined with the associated perifollicular inflammation, appears to generate substance P release at scale. The timing is characteristic: the scalp pain tends to arrive and intensify alongside the shedding wave, then gradually resolves as the acute phase passes.
The 2025 substance P study specifically enrolled AGA patients — meaning trichodynia in androgenetic alopecia is a documented phenomenon, not just in acute shedding. In AGA, the perifollicular inflammation that PIILIF research found in 81% of patients is a chronic, low-grade process — and it appears to generate a chronic, lower-intensity scalp sensitivity rather than the acute pain wave of TE. Trichodynia is classified among the allodynia — conditions in which pain is felt on the skin without recognisable external causes or appears to be caused by usually innocuous stimuli. The scalp that hurts when you just touch your hair gently is exhibiting allodynia driven by this sensitisation process.
The 2025 JDIN study (Desir et al.) found that the location and character of scalp pain in scarring alopecias offers clinically useful information about which subtype a patient has. This directly connects to the CCCA article published last week — CCCA patients often experience scalp tenderness or burning at the crown before visible scarring hair loss appears. Scalp pain, tenderness, and burning are early symptoms of active inflammation in scarring alopecias — and their location corresponds to the distribution of the inflammatory process. Pain that is localised to the crown and spreading outward warrants evaluation for CCCA. Pain at the hairline with lichen planopilaris pattern warrants evaluation for frontal fibrosing alopecia.
Another cause of trichodynia is neuromuscular inflammation of skin overstressed by the tendency to grind one's teeth — especially at night (bruxism) — with the subsequent contraction of the temporomandibular joint that, with the passing of time, involves the cranial muscles, causing headaches and trichodynia. The temporalis muscle attaches to the galea aponeurotica — the same fascial layer the scalp tension article covered as creating the tension gradient that concentrates AGA hair loss at the vertex. Jaw clenching and bruxism tighten the temporalis, which increases galeal tension, which may contribute to both scalp pain and the vascular compression that feeds PIILIF inflammation. If you clench your jaw at night and have scalp pain, these may not be independent symptoms.
What helps trichodynia?
Treatment depends on the underlying cause — which is why identifying it correctly is the first step.
A paper published in June 2026 (Saceda-Corralo et al., Dermatology and Therapy) explored botulinum toxin injections for trichodynia in 21 patients who had already tried conventional therapies without adequate relief. 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.
For the more common trichodynia associated with telogen effluvium and AGA, the treatment approach follows the underlying condition:
Frequently Asked Questions
What is trichodynia?
Trichodynia is the medical term for scalp pain, burning, or tenderness at the hair roots — often occurring during or alongside hair loss. It affects approximately 35.7% of people with hair loss disorders and is more common in women. It is a symptom, not a standalone diagnosis, and usually reflects an underlying hair loss condition or inflammatory process.
Why does my scalp hurt when my hair falls out?
A January 2025 study found tissue levels of substance P — a neuropeptide that amplifies pain signals — were nearly six times higher in trichodynia AGA patients than in healthy controls. The perifollicular inflammation associated with hair loss sensitises scalp nerve endings, making normally painless stimuli feel uncomfortable. The pain is a real neurochemical event, not a psychosomatic one.
Is scalp pain a sign of hair loss?
Scalp pain frequently accompanies hair loss and can occur before significant visible shedding begins — particularly in scarring alopecias where it is an early inflammatory sign. In telogen effluvium, it typically peaks with the shedding wave. In AGA, it tends to be a lower-level chronic sensitivity. A 2025 JDIN study confirmed that the location and character of scalp pain offers diagnostic clues about which type of alopecia is present.
What is burning scalp syndrome?
Burning scalp syndrome is another name for trichodynia — specifically describing the burning sensation variant. It is characterised by burning, stinging, or heat sensations at the scalp surface and hair roots without visible skin lesions. The mechanism involves neurogenic inflammation and substance P release from sensitised scalp nerve endings.
Can scalp pain be treated without medication?
For trichodynia associated with telogen effluvium or AGA, addressing the underlying inflammatory drivers — cortisol reduction, anti-inflammatory scalp care, pH-balanced microbiome support — reduces the perifollicular inflammatory environment that drives substance P release and nerve sensitisation. This does not work overnight and is not equivalent to the immediate relief some medications provide, but it addresses the mechanism rather than just the symptom. For severe or refractory trichodynia, medical evaluation is warranted before assuming the self-care approach will be sufficient.
What to do if your scalp hurts.
First — note when it happens and where. Diffuse scalp tenderness during a shedding wave points to telogen effluvium. Localised pain at the crown, spreading outward, warrants evaluation for CCCA. Pain at the frontal hairline with recession warrants evaluation for frontal fibrosing alopecia. Generalised low-grade sensitivity in an AGA pattern is the substance P mechanism the 2025 study described.
Second — reduce the inflammatory substrate. The anti-inflammatory botanical care, pH-balanced scalp environment, and cortisol reduction this series has covered are all addressing the perifollicular inflammatory environment that drives substance P release. This is not a specific trichodynia treatment — it is the same daily ritual, now understood to also be relevant to the pain symptom that one-third of hair loss patients experience and rarely report.
The scalp pain is not in your head. It has a measurable mechanism, a documented neurochemical substrate, and a clinical significance that now extends to helping identify which type of hair loss you have. It deserves to be reported to your clinician — not dismissed.
And the reason is telling you something specific about what's happening underneath.
Reducing the inflammatory substrate — daily.
Anti-inflammatory botanicals, pH-balanced microbiome support, cortisol reduction — the daily ritual addresses the perifollicular inflammatory environment that drives substance P release and scalp sensitisation.
→ Explore the Stress Collection → Explore Hair TreatmentsScience, ritual, and botanical intelligence — delivered daily.
Each morning, one article. New research, ancient wisdom, and the honest science of hair and scalp health. Written for women who want to understand what is happening — not just what to buy.
By subscribing you agree to receive email from Laritelle Organic. Unsubscribe at any time.