Headache with a Tender Scalp Lump: Could It Be a Tension Headache?

A headache accompanied by a soft, tender lump on the scalp that comes and goes is often consistent with a tension-type headache with associated pericranial muscle tenderness. Tension headaches are the most common primary headache disorder.

Typical Features

• Bilateral, pressing/tightening pain (like a band)
• Mild to moderate intensity
• Not worsened by routine activity
• No nausea/vomiting (may have photophobia or phonophobia)
• Tender scalp, neck, or shoulder muscles

When to See a Doctor

Seek evaluation if:

• Headache pattern changes or worsens
• Lump is fixed, growing, or painful without headache
• Neurologic symptoms (visual changes, weakness, numbness)
• Fever, weight loss, or history of cancer
• New onset after age 50

Management

• OTC analgesics (NSAIDs, acetaminophen) – limit to <15 days/month to avoid medication-overuse headache
• Stress management, posture correction, physical therapy
• Preventive medications (amitriptyline, etc.) for frequent episodes

A clinician can distinguish tension headache from migraine, sinusitis, cervicogenic headache, or secondary causes.