When a lump appears on the scalp and causes pain when pressed, it naturally causes concern. The location, often right against the skull, can make the sensation feel more alarming than a similar lump elsewhere on the body. While a healthcare evaluation is necessary to determine the precise cause, the vast majority of these growths are benign and represent easily manageable conditions. The pain itself is usually a direct result of inflammation, infection, or pressure on surrounding tissues.
Common Benign Causes of Pain and Swelling
Pain upon palpation typically indicates the lump is actively inflamed, infected, or mechanically irritating nearby structures. A common cause is an infected cyst, such as pilar cysts (filled with keratin around hair follicles) or epidermoid cysts (containing keratin debris). These cysts are usually painless until bacteria enter, triggering an inflammatory response that causes swelling, redness, and significant tenderness. The resulting pressure buildup from inflammatory fluid and pus is what makes the lesion acutely painful when touched.
Infections of the hair follicle (folliculitis) or deeper collections of pus called abscesses (boils or furuncles) are also frequent causes of tenderness. These lesions start as small, red bumps that become increasingly painful as the infection progresses and pus forms within the confined space. Pressing an abscess causes pain due to the mechanical compression of this sensitive, pus-filled pocket.
Lumps resulting from minor trauma, often called a “goose egg,” are hematomas—collections of clotted blood beneath the scalp tissue. The tenderness is directly attributable to acute swelling and bruising, which stretches the scalp’s pain-sensitive layers. Lipomas, which are soft, fatty tumors, are generally painless but can become tender if they grow large enough to press on adjacent nerves or if they are a rare variant called an angiolipoma.
Warning Signs and When to Seek Urgent Care
While most painful scalp lumps are benign, certain associated signs warrant prompt medical evaluation to rule out rare but serious conditions. If the lump is growing very quickly, such as doubling in size over a few weeks or months, it requires immediate assessment.
Urgent medical attention is necessary if the lump exhibits any of the following characteristics:
- It changes color, bleeds spontaneously, or develops an ulceration on its surface.
- It is accompanied by systemic indicators like unexplained fever, drenching night sweats, or unintentional weight loss.
- It feels fixed or immovable, suggesting attachment to underlying bone or deeper tissue.
- It is accompanied by new neurological symptoms, such as persistent, severe headaches, vision changes, confusion, or difficulty with balance.
The Diagnostic Process
A healthcare provider begins the diagnostic process by taking a thorough medical history, noting the lump’s duration, pain characteristics, and any recent injury or illness. This is followed by a physical examination to assess the lump’s size, consistency (soft, firm, or hard), and whether the overlying skin is warm or discolored. Assessing the lump’s mobility—whether it moves freely or is fixed to deeper structures—helps differentiate benign masses like cysts or lipomas from more concerning growths.
If the diagnosis is unclear after the physical exam, imaging studies may be ordered to visualize the internal structure. Ultrasound is often the first choice, determining if the lump is solid (like a lipoma or tumor) or fluid-filled (like a cyst or abscess). For lesions fixed to the skull or those with neurological symptoms, a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) may be used to assess bone involvement or deeper tissue extension. The definitive way to identify the cellular composition of the lump is through a biopsy or fine-needle aspiration, which collects a small tissue sample for laboratory analysis.
General Treatment Paths
Once a diagnosis is confirmed, treatment is determined by the lump’s specific nature. For small, stable lipomas or resolving hematomas, the approach is conservative, focusing on observation and pain relief with over-the-counter medication. Minor traumatic hematomas often resolve spontaneously within a few weeks as the body reabsorbs the clotted blood.
In cases of infection, such as folliculitis or an inflamed cyst, medical management involves oral or topical antibiotics. If the lump is an abscess or severely infected cyst, procedural intervention is usually necessary, involving incision and drainage to remove the pus and relieve the internal pressure. To prevent recurrence, the entire cyst wall may need surgical excision in an outpatient procedure. If a malignant finding is identified, the patient is referred to specialized care, such as oncology or neurosurgery, for treatment planning.