What could be causing severe headaches and scalp tenderness for 3-4 years?

Your symptoms could suggest a condition called allodynia, where normal sensations, like touching your scalp, become painful. This sometimes occurs with chronic migraines, which aligns with your history of migraine symptoms. Chronic tension-type headaches, or a condition known as trigeminal neuralgia, could also be potential causes. Another consideration is temporal arteritis, which affects blood vessels in the head and can cause scalp tenderness and headaches, especially in people over 50 years old. Furthermore, it’s vital to rule out structural causes like tumors or any other neurological conditions. Given the severity and duration of your symptoms, it would be reasonable to consult a healthcare professional for a comprehensive evaluation. They might recommend imaging like an MRI or CT scan to rule out more serious underlying causes. Blood tests may be needed too, particularly if temporal arteritis is suspected, which can be checked through a blood test called an Erythrocyte Sedimentation Rate (ESR) or a C-reactive protein level. Management ideally starts with a thorough assessment. Your doctor may recommend preventive medications for migraines or specific treatments depending on the diagnosis. For immediate but short-term relief, over-the-counter pain relief medicine could be suggested unless you have contraindications. Consistent follow-up is crucial, as these symptoms shouldn’t be ignored and may require specialized treatment. Remember, if you ever experience sudden vision changes, speech difficulty, or a severe, abrupt headache, you should seek urgent medical care.