Ponytail Headaches: Is Your Hairstyle Triggering Migraine Attacks?

Ever feel like your hair hurts?

"Hair-triggered migraine" or "ponytail migraine" starts as an external compression headache. The migraines are caused by a stimulus outside your head – i.e., hair being pulled too tight or wearing restrictive headwear. Ponytail headaches are common, and they're classified as a type of allodynia: pain from a stimulus that should only produce sensation.

Today, Sarah Alexander-Georgeson discusses her hair as an unexpected migraine trigger. She also shares her top tips to avoid a sore or aggravated scalp!

I've always had a sensitive scalp prone to extreme soreness. My mom and grandma would carefully brush my hair as a child because the slightest tug was agony.

But what does this have to do with migraine? 

Well, I started getting migraines in my early teens, but I always wore my hair in a ponytail. I hated having my hair on my face as it was long, thick, and constantly getting in the way. 

When I'd get home from school, I used to race through the door in a rush to get my ponytail down. My scalp felt like it was on fire - every strand of hair hurt as it pulled at my skin and caused a world of pain. But, when I unwound that tight hair bobble every evening, the relief was instant. 

How tight hairstyles or heavy hair can trigger migraine 

 At the time, I hadn't heard of "ponytail migraine" or of hair as a migraine trigger. In fact, I never considered that tying up my hair had anything to do with my pain issues. But, as I got older, I stopped wearing my hair back because I had too many migraines. 

Now for a short, science-y bit: 

Scalp tenderness links to the extremely sensitive nerves that run from the back of the neck to the forehead. 

 A tight style, like a ponytail, triggers a sensation of tightness in too many of these nerves, and you can get a horrible, grinding headache. The stress and sensation of this pain can trigger a full migraine attack – hence "ponytail migraine." 

I later discovered this could be allodynia, which can mean feeling pain at the softest touch. If you feel the onset of a ponytail migraine, the first thing to do is take your hair down. 

Now that I keep my hair in a more relaxed style, my long locks only trigger a migraine when I need to wash it. The grease build-up adds more weight to my hair, inflaming the nerves and causing scalp pain. 

I wash my hair twice a week and refrain from using any product, as it builds quickly and defeats the purpose of not adding extra weight.

Experimenting with hairstyles to manage flare-ups

I've experimented with some up-dos when I need my hair out of my eyes. A loose bun on top of my head works best. Using a scrunchie (a fabric-colored hair elastic) prevents pulling, as the hair doesn't wrap around or get caught in a tight bobble. 

Migraine also prevents me from wearing many hairbands, clips, or anything restrictive, like a sleep mask. Like a tight hairstyle, restrictive headwear may cause an external compression headache.

At first, I worried I couldn't wear hats again. I like to look good however my illnesses make me feel, and hats are an essential accessory in my wardrobe. I went through months of trial and error, testing different hat styles and seeing which ones I could withstand. Thankfully I've found a few – and taking off a hat is much easier than pulling out a ponytail!

As well as hats and hairstyles, I've also experimented with different haircuts. Before I knew how much my hair triggered scalp pain and migraine attacks, I asked my hair stylist for a "pixie cut" around twelve years ago.

The stylist removed my long locks and shaved one side of my head. I wore my hair like this for about five years and soon noticed quite a change in my migraines. Of course, they didn't totally disappear, but my hair was so short it didn't aggravate my scalp sensitivity. What a relief!

Finding the right "pain-free" haircut

But going to the salon wasn't entirely pain-free. I needed to return for a trim and a color every few weeks. When going over to the basins for a shampoo, I braced myself for another migraine attack.

I know some people love having their hair washed by a professional - but I hated resting my head on the sink, as the hard edge would dig into the base of my skull.

Eventually, I spoke to the stylist about my discomfort, and they responded by rolling up a towel as a makeshift pillow for my neck. It worked!

I noticed I had fewer migraines with shorter hair, but I did not put two and two together about why. However, it soon became noticeable when I started growing my hair again. Although it's been the root of some suffering, I love longer locks and was getting bored of the same style.

Yet, it did not take long for the scalp pain to start again or for the return of the ponytail migraine. I deliberated about re-cutting my hair but forgot how much of a genius my stylist was.

When I explained that I wanted to keep my hair long but was not sure how, he cut in hundreds of messy, grungy layers while keeping the length. I was in love - it matched my style, and the layers meant it was light enough to not trigger hair-related migraine attacks. I want to keep this look for a very long time.

7 tips to prevent your hair from triggering migraine

So, if your hair is also a migraine trigger, here are my top tips for keeping your style pain-free:

1. Don't wear tight styles like ponytails, ballerina buns, or braids... they look pretty, but they're not worth the sore head or scalp tenderness a few minutes on. 
2. Avoid getting hair extensions, even if you regret a haircut choice. Hair extensions are heavy and will aggravate scalp sensitivity. 
3. Don't wear anything restrictive on your head, like hairbands, sleep masks, or tight hats. 
4. Get plenty of layers chopped into your hair. You'll have both volume and a wonderful sense of weightlessness. 
5. Book appointments to have your hair thinned at least once every few weeks. 
6. Use dry shampoo to refresh between hair washes. 
7. Experiment with different styles and accessories to see what's pretty and pain-free!

The takeaway

Hair is a surprising migraine trigger, and, unfortunately, I can't offer any blanket advice on improving the situation. It would be easy to tell people to "cut their hair short," but many people don't find short hair flattering on themselves. I also don't think short hair is my style anymore, but long hair can take its toll.

On the plus side, getting my hair cut so often keeps it in excellent condition, and I don't ruin the texture with too-tight hair bands or greasy products. A super-loose bun with a scrunchie causes me no problems, and I can quickly put it up or take it out, depending on the style I want that day. Knowing my hair is a migraine trigger, I'm cautious about how I treat my sensitive scalp!

I know how you wear your hair is important to many people - but don't sacrifice your health for the sake of high-maintenance, celebrity style. Trust me – you'll feel much better!

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen​. 

NPS-ALL-NP-01020 JUNE 2023