Scalp trichilemmal cysts and headache: a correlation with tension-type headache features in an adult female patient—a case report

INTRODUCTION: Tension-type headaches (TTH) are prevalent primary headache disorders, affecting approximately 42% of the global population. Characterized by mild to moderate bilateral head pain, TTHs lack symptoms like photophobia and nausea (unless sometimes chronic TTH), distinguishing them from other headaches. They impose significant personal and societal burdens, particularly in high-income countries. Pathophysiology involves genetic factors, myofascial processes, and central sensitization. Gender disparities in healthcare further complicate diagnosis and treatment, often leading to misdiagnosis in women. CASE PRESENTATION: A 56-year-old Middle Eastern woman presented with a 10-month history of moderate occipital headaches, exacerbated by pressure. Initial misdiagnoses attributed her symptoms to psychological factors due to the patient's gender, leading to inadequate treatment. A comprehensive neurological examination was conducted, revealing no neurological deficits but identifying two tender cysts on her scalp. Imaging studies confirmed subdermal and extracranial masses, diagnosed histologically as trichilemmal cysts. These findings suggested a potential link between the cysts and her headache symptoms. CONCLUSION: While trichilemmal cysts are typically benign and asymptomatic, their presence on the scalp may contribute to bilateral discomfort with pain localized closer toward her trichilemmal cysts, exacerbating headache symptoms. This case highlights the importance of thorough physical examinations and consideration of atypical headache causes.