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Are you experiencing something crawling on your head or a tingling sensation in the scalp? The medical term for this condition is called formication and it is quite common. Formication is also a type of paresthesia which is defined as tingling dermal sensations. Causes of crawling sensations on the scalp include delusional infestations, hallucination, substance abuse, a parasitic infestation, side effects from medication, or issues with the neurologic system. Read below for more information on why you may feel like bug are crawling on your head.
4 most common cause(s)
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Formication symptoms explained
Formication is the medical term for a sensation of something (usually small insects) crawling on or under the skin. Often formication is associated with no obvious physical cause or external trigger. It is a fairly common occurrence many people can remember a time where they swatted or scratched at such a sensation only to find no bug, insect or bite in sight.
If periodic or occasional, formication can be a natural sensory occurrence that quickly resolves without much effort or thought; however, when such sensations become chronic or incessant, medical attention may be required. Individuals who experience chronic symptoms of formication may go on to develop symptoms such as:
- Intense itching (pruritus)
- Abrasions or lesions from excessive scratching
- Difficulty concentrating
- Depression/depressed mood
The excessive scratching that often accompanies formication is also an important symptom. Though scratching can be helpful in relieving a crawling sensation, it only offers temporary relief. Scratching can result in breaks in the skin that can lead to bleeding or infection, further exacerbating the issue.
If you are experiencing any of the symptoms above, seek medical attention. Formication and its associated symptoms often require the help of a multidimensional medical team including psychiatrists, dermatologists, and general medicine doctors.
Why does it feel like something is crawling on your head?
Formication is a type of paresthesia. Paresthesias are defined as dermal sensations with no apparent physical cause. Paresthesias include sensations such as prickling, tingling, or numbness sensations many define as "pins and needles."
These sensations are usually caused by transient disruption or pressure on the nerves in the affected area; for example, sitting with the legs crossed for too long can easily produce such sensations. However, when symptoms become chronic in nature, the causes become more nuanced.
Since formication does not have an obvious physical cause, many people who suffer from chronic formication often have a psychiatric etiology contributing to their symptoms. A psychiatric disorder is that relating to mental illness.
- Delusion: Some people may suffer from delusional infestations in which they have the fixed, false belief (delusion) that they are infected by parasites, worms, mites, bacteria, fibers or other living organisms despite no evidence of an infection or infestation.
- Hallucination: Some people may suffer from the hallucination (experience of something not there) of bugs or insects crawling on or under the skin. Such individuals may see the bugs on their skin when there is nothing actually there.
- Toxic: Substance abuse can often cause sensations of crawling on the head and under the skin. Chronic alcohol use and withdrawal and long-term cocaine and amphetamine abuse are common precipitants of these symptoms the term "cocaine bugs" are heavily described in the literature.
Though it is easy to think that the feeling of something crawling in the hair or on the body is "all in your head," there are concrete causes from the environment that may be causing your symptoms as well.
- Parasitic: Small, parasitic insects such as lice that feed on their host's blood and propagate by personal contact are a very common cause of such symptoms. They can inhabit the head, body and even pubic area and cause sensations of tickling or movement in addition to intense itching.
- Medication: Certain prescription drugs, corticosteroids, and some antibiotics, for example, may induce formication and its associated symptoms.
Chronic paresthesia, in general, is usually a symptom of an underlying condition or problem affecting the nerves. Although paresthesia specifically involving the sensation of crawling on the head or under the skin is more commonly associated with psychological causes, it is also important to consider medical causes of symptoms as well.
- Neurologic: Paresthesia can be caused by disorders affecting the central nervous system, such as strokes and multiple sclerosis (MS). Neurologic conditions that put pressure on the nerves, such as a tumor, can also cause paresthesia. Nerve entrapment syndromes, for example, carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia that is also associated with pain.
- Metabolic: There are many systemic, metabolic conditions that can result in damage to the nerves of the body. These conditions affect the way that the nerve sends and receives signals from the brain and spinal cord and disrupts proper sensory function. Conditions such as diabetes, thyroid disease, and vitamin deficiencies often result in paresthesias, though they are less associated with crawling sensations specifically.
This list does not constitute medical advice and may not accurately represent what you have.
Seborrheic dermatitis is a common chronic inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp, face or inside the ear. It can occur with or without reddened skin. The exact cause of this condition is not known, although doctors think that some common skin yeast organisms, called Malassezia, may play a role in some people.
You should go to a retail clinic to be treated. There are a variety of medicated creams that are used for this condition such as prescription or over-the-counter shampoos containing zinc pyrithione, hydrocortisone, selenium sulfide, or salicylic acid.
Top Symptoms: itchy rash, red or pink, rough patch of skin, rash with well-defined border, scalp skin changes, cheek skin changes
Symptoms that never occur with seborrheic dermatitis: fever
Urgency: Phone call or in-person visit
Ringworm of the scalp (tinea capitis)
Ringworm of the scalp, also called tinea capitis, is caused by a microscopic fungus and not by an actual worm.
Any type of ringworm is easily spread through direct contact with a person, or a pet animal, who has the infection; or through direct contact with the hairbrushes, clothes, towels, bedding, or other items that an infected person has used.
Most susceptible are pre-school and school-age children, and anyone with a weakened immune system.
Symptoms include itchy, scaly, round-appearing patches of hair loss on the scalp.
It is important to see a medical provider for symptoms of scalp ringworm, both to help ease the discomfort and to prevent the spread of the condition to others.
Diagnosis is made through physical examination and sometimes a skin sample for testing.
Treatment involves washing all clothes and bedding in hot water and detergent, and using an antifungal shampoo as well as a prescribed cream or gel for the affected spots on the scalp. Sometimes a course of antifungal tablets will also be prescribed.
Top Symptoms: scalp itchiness, patchy hair loss, scalp redness, scaling of the scalp, rash
Urgency: Primary care doctor
Normal episode of itchy skin
Itchy skin is also called pruritis. There are a number of "normal" causes for itching, meaning the cause is not disease-related and does not result in seriously damaged skin.
The most common causes are:
- Dry skin, due to bathing in soap or bubble bath that may be too harsh and is stripping the natural oils from the skin.
- Mild allergies, which may be caused by dust; certain plants and flowers; nickel-containing jewelry; and any sort of soap, detergent, lotion, or perfume.
- Pregnancy, due to stretching of skin or to a condition called prurigo. Prurigo causes small, itchy bumps which may be due to an autoimmune system dysfunction during pregnancy.
- Menopause, due to hormonal changes that may leave the skin overly dry.
Diagnosis is made through physical examination and sometimes allergy tests.
Treatment involves bathing only with mild, hypoallergenic soap; regular moisturizing with unscented lotion; wearing soft, loose, non-synthetic clothing; avoiding any substances that seem to provoke the itching; and sometimes prescription medicated creams.
Multiple sclerosis (MS)
Multiple sclerosis, or MS, is a disease of the central nervous system. The body's immune system attacks nerve fibers and their myelin covering. This causes irreversible scarring called "sclerosis," which interferes with the transmission of signals between the brain and the body.
The cause is unknown. It may be connected to a genetic predisposition. The disease usually appears between ages 20 to 50 and is far more common in women than in men. Other risk factors include family history; viral infections such as Epstein-Barr; having other autoimmune diseases; and smoking.
Symptoms include numbness or weakness in arms, legs, or body; partial or total loss of vision in one or both eyes; tingling or shock-like sensation, especially in the neck; tremor; and loss of coordination.
Diagnosis is made through patient history, neurological examination, blood tests, MRI, and sometimes a spinal tap.
There is no cure for MS, but treatment with corticosteroids and plasma exchange (plasmapheresis) can slow the course of the disease and manage symptoms for better quality of life.
Lice are tiny insects without wings that are usually found in hair, back of the neck, and behind the ears. Lice are highly contagious and prevalent in preschool & elementary school-age children.
You should go to a retail clinic to be treated for lice. Treatment includes using a medicated shampoo, cream rinse, or lotion to kill the . Over-the-counter and prescription medications are also available.
Formication treatment options
When to see a doctor for formication
Treatment for formication and its associated symptoms requires a thorough assessment of the person's situation including a thorough history, drug screen, and physical examination.
Treatments for formication
The key in treating feelings of something crawling on the head or under the skin is to find the root cause whether that be psychiatric, medical or environmental etiologies. The root cause of the symptoms will dictate the appropriate treatment.
- Psychiatric: Treatments such as cognitive behavioral therapy (CBT), counseling, and antidepressant or antipsychotic drugs are the principal modalities used in treating psychiatric causes of formication. In addition, drug rehab programs to help people stop abusing alcohol and cocaine may also be utilized as treatment.
- Environmental: Proper treatment of a parasitic infestation such as lice or scabies includes over-the-counter and prescription medications that specifically target parasites and kill them. It is also important to take preventative steps at home such as washing combs and brushes, not sharing personal belongings such as hats or scarves, and washing and decontaminated any used linens or bedding.
- Medical: Since the medical causes of formication can be varied, your doctor will run the appropriate diagnostic tests in order to uncover the root cause of your symptoms and begin appropriate treatment.
FAQs about feeling of something crawling on head
What kinds of prescription drugs can cause formication?
Often it is not the drug itself that causes symptoms but rather withdrawal from the prescribed drug that results in feelings of crawling on the head or under the skin. Withdrawal from
opioid pain medications (codeine, morphine), antidepressants (SSRIs), cocaine, heroin, and methamphetamine can lead to this symptom. Discuss with your doctor your prescribed drug and proper withdrawal.
Can formication be treated?
Yes, formication can be treated. Treatment will depend on the specific cause of your symptoms whether they are psychiatric or medical in nature. Your diagnostic team will include a multifaceted team of physicians including dermatologists, psychiatrists, and medical doctors.
Is formication life threatening?
The actual sensation of crawling on the head or under the skin is not dangerous in itself; however, these symptoms can have serious complications. For example, some people may scratch incessantly at the sensation, causing lesions or breaks in the skin that may lead to infection.
Am I crazy for feeling like something is crawling on my head?
You should not feel crazy or embarrassed about experiencing such symptoms. Even if your symptoms are psychiatric in nature, your experience of this sensation is affecting the quality of your life and you deserve to be taken seriously. Even if you are feeling negative about yourself during this time, it is important to seek medical attention that validates your symptoms and concerns and works to help you achieve relief.
Will the crawling on my head spread to other parts of my body?
If your symptoms are caused by parasites, they may spread to infect not only your head but also other parts of your body. However, if your symptoms are the result of other causes, it is not clear-cut as to whether the sensations will spread to include other body parts. Either way, it is important to seek medical attention for your symptoms in order to get the most appropriate treatment.
Is the sensation contagious?
Crawling on the head or under the skin is only contagious in situations of parasite infestation. Lice are extremely contagious and easily transferred via body-to-body contact, body-to-infested material contact, etc. It is very important to get a lice diagnosis promptly in order to prevent spread.
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- Hylwa SA, Bury JE, David MDP, et al. Delusional Infestation, Including Delusions of Parasitosis. JAMA Network. Published September 2011. JAMA Network Link
- Suh KN, Keystone JS. Delusional Infestation: Epidemiology, Clinical Presentation, Assessment and Diagnosis. UpToDate. Updated June 7, 2018. UpToDate Link
- Litt J. Formication. Psychology Today. Published November 3, 2009. Psychology Today Link
- Mayo Clinic. Published May 19, 2018. Mayo Clinic Link
- Morgellons Disease: Managing an Unexplained Skin Condition. Mayo Clinic. Published April 10, 2018. Mayo Clinic Link
- Paresthesia Information Page. National Institute of Neurological Disorders and Stroke. Updated June 14, 2018. NINDS Link
- Crawford J. What is Formication? Medical News Today. Updated May 23, 2018. Medical News Today Link