Why Is My Hairstyle Giving Me a Headache?

Q: I wear hairstyles like box braids, cornrows and sleek ponytails, but sometimes they make my head hurt. Why does that happen? Should I be worried?

How you wear your hair is often about more than looking and feeling good. For some people, a hairstyle is a form of self-expression, making a little pain seem worthwhile.

For others, it’s a way to feel connected to cultural heritage, said Dr. Victoria Barbosa, an associate professor of dermatology at the University of Chicago. And sometimes, slicked-back buns or protective styles like summertime braids, which are meant to safeguard your hair from damage, are just convenient, she said.

But any hairdo that involves tugging can trigger what experts call external-traction headaches; and consistent tension can lead to hair loss.

“No one wants to spend their hard-earned money, often hundreds of dollars, on a style that they then have to take down prematurely,” Dr. Barbosa said. “But sometimes it comes to that.”

How Tight Hairstyles Trigger Headaches

Tension headaches cause a dull pain or pressure, or the feeling of a tight band, around your head. But external-traction headaches — which experts previously called ponytail headaches — are primarily felt where hair is pulled, said Dr. Susan Broner, a neurologist at NewYork-Presbyterian Hospital.

Sporting a high ponytail, for instance, may cause your crown to hurt, while newly installed cornrows could lead to pain across your scalp. This happens because hairstyles can trigger sensitive nerve endings on the scalp, said Dr. Annie Shea, a neurologist at University of Michigan Health.

But these hairstyles won’t cause long-term nerve damage, she said. In most cases, you should feel better within an hour of loosening your hair.

To avoid these headaches altogether, Dr. Shea suggested opting for looser styles. If you need to get hair out of your face, such as during a workout or while cooking, she recommended hair clips and soft headbands.

If you’re wearing tight braids, it’s harder to let your hair down. Box braids — which are installed by parting hair into sections, or boxes, and braiding each one — put tension on hair roots because they typically involve placing hair extensions right at the scalp. Knotless braids, however, feed extensions into the braids in a way that causes less tension, Dr. Barbosa said.

In situations where looser styles aren’t possible, Dr. Shea suggested taking a pain medication like ibuprofen before a hair appointment, or even after the pain sets in.

Still, it’s important to tell your braider if you’re in pain as your hair is being styled, Dr. Barbosa said, “because once the style is in, of course someone can take pain medicine, but that doesn’t change the fact that the style is too tight.”

Long-Term Effects of Tight Hairstyles

Any style that adds friction or tension to the hair can cause it to snap. Regularly using hair ties, for instance, means elastic bands rub against hair “like a little knife,” Dr. Barbosa said.

Traction alopecia, a type of hair loss caused by constant pulling at the hair root, is another risk. Early on, this may look like a receding hairline or patches of hair loss. It may also appear as “acne bumps or flaking on the scalp,” said Dr. Jordan Talia, an assistant professor of dermatology at Mount Sinai.

If someone continues to wear styles that pull at their hair, the condition can worsen, causing scar tissue that may destroy the hair follicle and leave skin shiny and permanently bald.

Anyone can experience traction alopecia, but it’s most prevalent among Black women, specifically those who wear styles with tension, Dr. Barbosa explained. Though it’s unclear why, the risk may also increase for people with chemically straightened hair, experts said.

“It is such a common problem that, even though it’s not normal, it has become the norm,” Dr. Barbosa said.

There are treatment options to manage traction alopecia: Earlier on, a dermatologist may prescribe a topical steroid, or inject steroids into a patient’s scalp to decrease inflammation and prevent scarring, Dr. Talia said. And they might also recommend minoxidil (Rogaine), an over-the-counter topical medication that stimulates hair growth. Oral minoxidil is also available by prescription, which dermatologists use as an off-label therapy for the condition, Dr. Barbosa added. (The Food and Drug Administration hasn’t approved any medications for traction alopecia specifically, but topical minoxidil is approved for female- and male-pattern baldness.)

For those with permanent hair loss, hair transplants — which involve harvesting healthy hair follicles from skin on the scalp and transplanting them to where new hair is desired — may be an option, Dr. Barbosa said, though the procedure can cost thousands of dollars.

In general, Dr. Barbosa recommended that people avoid tight styles. When it comes to protective styles like box braids or cornrows, she suggested wearing them only once or twice a year, and for no longer than six weeks at a time.

These hairdos might be protecting your hair “because you’re not having the breakage associated with frequent hair styling,” but they could be damaging your follicles, she said. “Protective hairstyles are not always so protective.”