Nobody wants to have a bald head. Although some people may not care much about it, for many, hair loss (alopecia) can lead to a loss of self-esteem and may even cause anxiety, depression, and other emotional problems (1). And I suppose you know why — people associate rich hair with beauty, good health, youthfulness, and sexuality.
Hair loss is pretty common in our society. By the age of thirty-five, over 66 percent of American men will experience some degree of appreciable hair loss or thinning of hair, and that figure rises to about 85 percent by the age of fifty (2). The situation is very similar for women with about 80 percent affected by the age of sixty (3). It is worth knowing that pattern hair loss — androgenic alopecia — accounts for the majority of hair loss in both men and women.
Pattern hair loss is believed to be caused by a combination of genetics and androgen levels. Hair loss can also be caused by a lot of things, such as autoimmune conditions (alopecia areata), psychological stress, hypothyroidism, medications (cancer and HIV/AIDS medications), and malnutrition.
Recently, scalp tension is thought to play a role in the development of hair loss, especially pattern hair loss (4). Now, you may be wondering what scalp tension is and how it plays a role in hair loss. Just read on!
In this article, I will discuss what scalp tension is, how it comes about, the effects it can have on hair growth, the current theory of pattern hair loss, the role of scalp tension in pattern hair loss, and what you can do to prevent scalp tension and hair loss.
To understand scalp tension, you need to understand the structure of the scalp. The scalp is the layer of tissue that covers your skull — the bone of the head. It consists of the following layers from outside to inside:
The galea aponeurosis is a tough layer of dense fibrous tissue which connects the frontalis muscle (in the front) to the occipitalis muscle (in the back) (5). Owing to its position and structure, it can become tense when either of the muscles contracts or when it is irritated.
So, scalp tension arises when — for whatever reason — the galea aponeurosis becomes tense, creating a sort of tension in the scalp. A tense galea impinges on the blood vessels that pass through it to supply the structures above it.
These structures include the skin which bears the hair follicles and the subcutaneous connective tissue. When they are not well nourished, the intracellular biochemical processes going on within the cells, the inter-cellular physiological interactions among the cells, and ultimately, the structural integrity of the tissues will be affected, leading to improper hair nourishment, development, and growth.
In other words, the tension sets in a condition of chronic inflammation, which affects the process of hair growth and, at the same time, worsens scalp tension by causing excessive production of fibrous tissues — a vicious cycle.
But how does scalp tension come about? Which factors lead to it?
A lot of factors can make your scalp to feel tight or stiff. I will discuss the most common ones here:
Your hairstyle is one of the most common factors that can make your scalp tense. In as much as you want to look good and style your hair the way you like, be mindful of certain hairstyles that might be putting your scalp in a constant state of tension. Heavy braids and weaves can pull on the scalp, making it stiff.
If your scalp is lacking moisture, it can easily become tense and itchy. And the more you scratch it, the more you irritate the galea aponeurosis which worsens the scalp tightness. A dry weather condition might affect your scalp texture. It doesn’t only dry your scalp but also leaves it scaly and stiff.
This is a condition of the scalp that causes scaly patches, scalp itchiness, and flaking. Its exact cause is not fully understood, and it’s not always related to poor scalp hygiene. Dandruff doesn’t only make the scalp very dry and scaly but also make it stiff and tense. The itchiness can also worsen the scalp tension because when you scratch the scalp, the aponeurosis tightens further.
Scalp injuries can make the scalp tense, and here is how: An injury on the scalp can irritate the muscles of the scalp and the galea aponeurosis, causing them to contract and become tense. In addition, when the injury is healing, there can be excessive deposition of fibrous tissues in the scalp which would worsen the scalp tension.
An infection of the scalp is one of the most common causes of scalp tension. The infection could be fungal, bacterial or viral in origin, but the effects are more or less the same — inflammation of the scalp leading to fibrosis and scalp tightness. Most of the time, there will be itching which will further worsen the situation when you scratch it.
Tension headache feels like a section of the head is tense or tight — as if there is pressure there. The severity may vary, but it’s often caused by stress and lack of sleep. If you frequently have tension headaches, you will notice that the overlying scalp feels tense as well.
Similarly, anxiety can make the muscles of the head to contract, including those of the scalp. This will often make the scalp stiff. People with anxiety disorders are more easily affected by a stressful condition and may experience tension headaches more often. So, they are more prone to scalp tension.
The type of hair products you use may cause your scalp to be tense, and here are the reasons. Wrong hair products can make your scalp dry and lead to scalp tension. But, more importantly, using bad hair products can lead to dandruff, which is another major cause of scalp tension. Furthermore, the chemicals in the products can irritate the muscles of the scalp, leading to contraction and scalp tightness.
The effects of scalp tension on the nourishment, regeneration, and growth of new hair follicles in the scalp are so many. Scalp tightness is now believed to affect the development of hair because when your scalp is in a state of tension, the following might happen:
When there is tension in the galea aponeurosis, blood flow to the tissues above it tends to reduce because the aponeurosis exerts pressure on the blood vessels passing through it to supply those tissues. The lack of nutrients which results from this will lead to poor development of new hair follicles.
Just like any other part of the body, excessive tension in the scalp can lead to inflammation of the scalp. If the inflammation is not identified and treated in time, it may lead to the formation of scar tissue which will further affect the blood supply to the scalp. Additionally, the inflammatory cells would have to share the available nutrients.
A tense scalp is more likely to develop tissues fibrosis than a relaxed one. Scalp tension leads to inflammation and chronic inflammation often leads to tissue fibrosis and scar tissue formation. This will reduce oxygen and nutrient supply to the hair follicles, leading to abnormal hair growth.
It is, therefore, very possible that scalp tension can contribute to the development of pattern hair loss. Sure, you would like to know how.
From what has been discussed so far, you can see that scalp tension can affect hair growth, so it can play some role in the processes that lead to pattern hair loss. But, first, we need to understand the current theory of pattern hair loss.
In the last five decades, numerous studies have shown that pattern hair loss is related to an individual’s genetic makeup, as well as androgen levels. This is probably why this type of hair loss is called androgenic alopecia. The androgen of concern is dihydrotestosterone, also known as DHT.
DHT is produced by the reduction of the hormone testosterone — a reaction catalyzed by the enzyme 5α-reductase. This enzyme is present in several tissues in the body, including the hair follicles. So, DHT can be produced in the hair follicles, and high levels of it can trigger hair loss.
Genetically, there are variations in the expression of 5α-reductase in the hair follicles. Some people tend to have a higher concentration of the enzyme in the hair follicles than others. In addition, the expression of DHT receptors in the scalp varies with the rest of the body, and some have more DHT receptors in the scalp than others.
But what does DHT have to do with hair loss? Well, studies have shown that people with hair thinning tend to have higher levels of DHT in the scalp (6). Again, men who were castrated before puberty — testosterone and DHT levels remain permanently low — don’t develop pattern hair loss later in life (7, 8). Moreover, people with 5α-reductase deficiency don’t suffer from androgenic alopecia (9).
If the DHT level in the scalp plays such a causal role in pattern hair loss, where does the scalp tension theory come in?
Even though DHT is a major factor in the development of pattern hair loss, removing DHT from the system does not lead to a complete hair recovery — it can only stop the progression of hair loss (10, 11). This may be related to the formation of fibrous tissues in the scalp which the elimination of DHT doesn’t take care of (12, 13).
Apart from causing scar tissue formation, scalp tension can cause an increase in the level of DHT in the scalp. Long-lasting tension in the scalp can trigger inflammation, and inflammation can lead to an increase in the level of DHT in the scalp, as observed in other tissues in the body (14, 15, 16).
Furthermore, scalp tension may help in answering the most critical question about DHT and hair loss: Why does DHT stimulate hair growth in other parts of the body but cause hair loss in the scalp? Here’s the answer: DHT stimulates the secretion of transforming growth factor beta 1 (TGFβ-1) in tissues under chronic tension (a tense scalp, for example) but not in tissues without tension (17, 18). TGFβ-1 is a signaling protein known for inducing fibrosis.
So, scalp tension can lead to inflammation and scar tissue formation, increase the level of DHT in the scalp, and cause DHT to stimulate further fibrosis in the scalp. All these would lead to reduced blood flow to the hair follicles and, ultimately, hair loss.
There several ways to prevent scalp tension or treat an already tight scalp. It all depends on your prevailing situation. From the possible causes mentioned above, you can identify what may be making your scalp stiff and take the necessary steps to manage it. If you have tension headaches or anxiety, go see your doctor to take care of it. You should also learn some stress management techniques.
Similarly, if you have dandruff or scalp infection, make sure you get it treated. Be mindful of the type of hairstyle you keep; you may want to avoid heavy braids or try not to carry them for a long time. Here are other things that can help you prevent scalp tension:
Scalp tension is now recognized as a contributory factor in the development of pattern hair loss because it can trigger inflammation and fibrosis in the scalp. Your hairstyle, scalp infection, and dandruff are some of the factors that can make your scalp stiff. With good scalp hygiene, you can prevent most of these factors that lead to scalp tension and avoid hair loss.
1. https://www.ncbi.nlm.nih.gov/m/pubmed/16307704/
2. https://www.americanhairloss.org/men_hair_loss/introduction.html
3. https://thehairsociety.org/hair-loss-statistics-the-facts/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639964/
5. https://emedicine.medscape.com/article/834808-overview
6. http://www.ncbi.nlm.nih.gov/pubmed/4823922
7. http://www.ncbi.nlm.nih.gov/pubmed/23769268
8. http://press.endocrine.org/doi/abs/10.1210/jcem-20-10-1309
9. https://www.ncbi.nlm.nih.gov/pubmed/4413434
10. https://www.ncbi.nlm.nih.gov/pubmed/10495374
11. https://www.sciencedirect.com/science/article/pii/S0022202X15529357
12. https://link.springer.com/article/10.1007/s00403-007-0826-x
13. https://www.nature.com/articles/sj.bdj.2010.252
14. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.1996.tb00568.x
15. https://www.ncbi.nlm.nih.gov/pubmed/11853085
16. https://www.goldjournal.net/article/S0090-4295(04)00409-1/fulltext
17. https://link.springer.com/article/10.1007/s00403-012-1265-x
18. https://www.researchgate.net/publication/231222952_Inui_S_Itami_SAndroge...
Emmanuel Ifeanyi Ekwomadu is a medical doctor and a writer who has a great passion for helping people enjoy healthy lives. He writes to enrich people with his compelling and educating articles on various health topics.
Contact him: anyiemadu@gmail.com