A friend of mine who has an AIDS diagnosis (since 1990) is doing well except that he is having severe pain in his head which seems to be localized in or below the hair follicles on top of his head on the right side of his scalp, i.e., it hurts him when his hair is touched or when pressure is applied there. He has a history of sinusitus in the right sinus. Last night the pain got so intense that his doctor had to proscribe a painkiller. This worked for the pain, but could the problem be related to his sinusitus? His sinuses were drained two years ago and he has had relief since then, so might another cleaning be needed? His doctor is stumped for now; she treated him for scales (although none were present) and he has only gotten worse.
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It is true that the nerves that supply sensation to the interior of the sinuses and nasal passages share pathways with many other nerves providing sensation to many locations surrounding the head and therefore, discomfort or pain originating in the sinuses may be felt in other locations. Common examples of referred pain from the sinuses include pain felt around or behind the eyes, pain felt in the teeth, pain felt in the back of the skull etc. However, the pain you have described is not consistent with referred pain that originates in the sinuses. First of all, the pain you are describing is associated with localized tenderness of the scalp itself. While the sinuses may cause the sensation of pain felt in other locations, it will not cause tenderness to touch in those same locations. In other words, the pain from a sinus infection may be felt in the upper teeth, but if you tapped on the upper teeth it should not cause increased pain. This is one means of differentiating pain originating in the tooth itself from that originating in the sinuses. If the pain and tenderness in the scalp which you have described is not associated with an obvious dermatological condition, then the next most likely cause would be a local problem with nerve endings such as a neuropathy. Neuropathies can occur due to viral infections of the nerves themselves. An important consideration in an immunocompromised individual would be a herpes zoster infection which typically causes severe pain in the skin in the area supplied by the infected nerve.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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