How Shingles May Cause a Headache

Remember to Get Vaccinated to Prevent Shingles

Shinges – A Painful Rash. Joel Carillet/Getty Images

Shingles is a painful and common skin disorder that affects approximately one million Americans every year, according to the Centers for Disease Control and Prevention, or CDC. Shingles may cause head and face pain if it affects a large nerve that innervates the face (called the trigeminal nerve).

Understanding Shingles

Shingles is a painful rash that develops along a nerve line (called a dermatome).

The rash forms as a result of reactivation of the chickenpox virus, which normally lies dormant in nerves in your body. The medical term for shingles is herpes zoster, which should not be confused with herpes, a sexually transmitted disease.

It's important to understand that anyone who has had chickenpox (or received the chickenpox vaccine) may develop shingles. That said, shingles is more common in adult over the age of 50, as well as in people with weakened immune systems (for example, people taking corticosteroids or people with lymphoma, leukemia, or human immunodeficiency virus (HIV).

Shingles and Headache or Facial Pain

Shingles can affect you anywhere on your body, although it affects the trigeminal ganglion in about ten to fifteen percent of cases—and this is what causes a person to have head or face pain. The medical term for head or facial pain that occurs as a result of shingles is "painful trigeminal neuropathy attributed to herpes zoster."

The trigeminal ganglion is where cell bodies of the trigeminal nerve converge to provide sensation to the face, mouth, and head. The trigeminal nerve consists of three major branches:

  • Ophthalmic branch, which is located near the eye
  • Maxillary branch, which is located n the cheek-area
  • Mandibular branch, which is located in the jaw-area

    The branch of the trigeminal nerve most commonly affected by herpes zoster is the ophthalmic branch.

    Shingles that affects the trigeminal nerve is usually described as a burning, tingling, itching, stabbing, or aching feeling in the head or face. People also describe a heightened sensitivity to touch in the area of the affected nerve (called allodynia).

    It's important to note that prior to developing the painful rash of shingles, some people experience prodromal symptoms like malaise, headache, sensitivity to light, unusual sensory disturbances (for example, itching or burning). Occasionally, people experience a fever. These symptoms may occur up to several days prior to the rash eruption.

    When the rash does it appear, it begins as red bumps that then turn into clear fluid-filled bumps, called vesicles. The vesicles scab within 7 to 10 days, and the scabs fall out in about two to four weeks. Sometimes the rash can leave a scar.

    Treatment of Shingles

    Shingles is treated with an antiviral medication, like Valtrex (valacyclovir) prescribed by your doctor. If the rash is around or near your eye, you will need to urgently see an eye specialist called an ophthalmologist.

    Finally, in addition to an antiviral medication, your doctor may prescribe pain medication to ease discomfort, which can range from mild to severe.

    Examples of pain medication your doctor may recommend or prescribe include:

    • Tylenol (acetaminophen)
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Corticosteroids 
    • Anti-seizure medications like Neurontin (gabapentin) or Lyrica (pregabalin).

    To soothe itching, wet compresses and calamine lotion may be helpful.

    A Couple Tidbits to Keep in Mind

    One important tidbit to keep in mind is that shingles is not contagious. That said, there is one exception. If a person has never had chickenpox (and never had the chickenpox vaccine) and comes into contact with the rash (when the rash is at the blister or vesicle stage), they may contract it.

    Shingles is not contagious prior to the rash forming or when the rash crusts. Even so, according to the Centers for Disease Control and Prevention, the risk of transmitting chickenpox from a shingles rash is low if the rash is covered. Still, if you have shingles, your doctor may advise you to not come into close contact with children who have not yet received the chickenpox vaccine.

    A second important tidbit is that shingles can be prevented. In fact, there are now two shingles vaccines. One vaccine is the live attenuated zoster vaccine (Zostavax) and the other is the inactivated recombinant zoster vaccine (Shingrix). The latter was approved for use in the United States in October 2017, and research suggests it may be more effective for preventing herpes, especially in older individuals.

    In addition to helping prevent shingles, these vaccines also help prevent postherpetic neuralgia—a painful and sometimes debilitating complication of shingles.

    A Word From Verywell

    When shingles affect the trigeminal ganglion, it can cause a painful rash of the head and face. That said, please seek medical attention right away if you think you may have shingles.

    In addition, if you are 60 years of age or older, speak with your doctor about receiving the shingles vaccine. In the end, preventing shingles from occurring in the first place is your best bet.

    Sources:

    Albrecht MA. (2017). Vaccination for the prevention of shingles (herpes zoster). Hirsch MS, ed. UpToDate. Waltham, MA: UpToDate Inc.

    Centers for Disease Control and Prevention. (2014). About Shingles (Herpes Zoster)

    Centers for Disease Control and Prevention. (2014). Update on Recommendations for Use of Herpes Zoster Vaccine.

    Headache Classification Committee of the International Headache Society. (2013). "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia, 33(9):629-808.

    Klasser GD, Ahmed AS. How to manage acute herpes zoster affecting trigeminal nerves.J Can Dent Assoc. 2014;80:e42.