Shingles is caused by a recurrence of varicella-zoster virus (VZV), which causes chickenpox during initial infection. After chickenpox symptoms clear, the virus becomes latent in a nerve cell; this nerve is later impacted during shingles. This generally occurs along the buttocks and trunk of the body, but a facial nerve can also be impacted, leading to symptoms on the scalp. Individuals experiencing facial involvement of shingles face unique complications; however, shingles is highly treatable.
The first symptom of shingles outbreak is pain occurring along the path of the nerve in which VZV has become reactivated. The pain varies in intensity between individuals from mild to very intense. In the case of pain in the scalp, pain in other areas of the face, including the eyes, ears and mouth may also be noticed, depending upon which nerve VZV is affecting.
Following the initial pain, a red rash with blisters develops. According to Seth John Stankus, MAJ, MC, this generally occurs two days after pain develops, but may take up to three weeks. When rash develops on the scalp, it may also affect the eyes, ears and other areas of the face.
According to the University of Michigan Health System, additional symptoms of shingles on the scalp include headache and weakness on the affected side of the face. This can lead to a drooping of one's facial muscles; shingles is one of the viruses that can lead to Bell's palsy, a condition which can also affect your hearing, according to the Mayo Clinic. An outbreak of shingles may also lead to Ramsay Hunt syndrome, a similar condition that may permanently affect hearing and muscle strength in the face, according to the Mayo Clinic.
The University of Michigan Health System reports that facial-muscle drooping associated with shingles on the scalp generally clears up but may take several months. People experiencing shingles on the scalp, like other shingles sufferers, may experience postherpetic neuralgia, a condition in which the pain of shingles lasts longer than the rash.
The primary treatment for shingles, according to Stankus, are orally administered antivirals and corticosteroids. Other drugs are used to manage pain, including either over-the-counter or narcotic painkillers based on the severity of pain. Stankus also recommends that cases affecting the eye should be referred to specialists for further examination and treatment.