The Centers for Disease Control and Prevention, or CDC, estimates that 30 percent of Americans develop shingles during their lifetime. The disease results when the varicella-zoster virus--the same virus that causes chickenpox--reawakens in clusters of sensory nerves near the spinal cord, called the dorsal root ganglia. Although the trunk and back are the most commonly involved areas, the head is sometimes affected.
Lesions
Shingles causes a rash that begins as red, swollen patches of skin that evolve--over a few hours--into 5mm to 10 mm fluid-filled blisters. New lesions develop in crops for three to five days, according to the CDC. In healthy people, these lesions rupture and crust between seven to 10 days, signaling the end of the infectious phase of the disease. However, two to four weeks may be required for complete healing. In the case of head shingles, says Mayo Clinic ophthalmologist Thomas J. Liesegang, these lesions appear on the scalp, anywhere on the face and inside the mouth, external ear canal or lids of the eyes. When shingles affects the eye itself, it can result in permanent changes in vision or even blindness, he says.
Flu-Like Illness
Many people with head shingles complain of systemic symptoms such as fever, headache, sensitivity to light, decreased appetite and an overall sense of malaise, says University of Alabama Medical School Professor Richard J. Whitely in the 2008 edition of "Harrison's Principles of Internal Medicine." People often mistakenly believe they are coming down with the flu or a cold. However, characteristic respiratory symptoms of these infections, such as dry cough and runny nose, never appear. Fever due to head shingles is typically low grade or even subjective. A person feels feverish, although the temperature measures as normal. Symptoms usually start a few days before skin lesions due to shingles appear on the head; they resolve when skin lesions crust or scab over.
Pain
Pain due to head shingles begins as mild tingling, burning, itching, stinging or soreness in the areas where lesions later appear. When lesions appear one to five days later, notes the CDC, pain worsens and may even be disabling. According to StopPain.org, some patients compare it to being stabbed by electricity. Pain may be set off by facial movements or even light touch, such as a faint breeze. For most people, pain resolves within one to two months. In up to 50 percent of patients, adds Whitely, pain persists even longer. This condition is known as post-herpetic neuralgia.
Brain Inflammation
In some people with head shingles, the disease turns inward, causing inflammation in the brain. Doctors call this condition encephalitis. According to the National Institute of Neurological Disorders and Stroke, symptoms of brain inflammation include fever, headache, sensitivity to light and vomiting. A key difference between brain inflammation and flu-like illness is that the latter presents gradually; symptoms due to brain inflammation start suddenly. Brain inflammation is also progressive. Patients soon demonstrate signs and symptoms that are clearly neurological, such as muscle weakness, poor coordination, lethargy, mental confusion and irritability. Without prompt initiation of antiviral drugs and steroids, patients may develop seizures or coma.
References
- "Harrison's Principles of Internal Medicine, 23rd Edition;" A.S. Fauci et al.; 2008
- Centers for Disease Control and Prevention: Herpes Zoster: Q and As for Providers
- StopPain.org: Shingles
- "Opthalmology;" Herpes Zoster Ophthalmicus; T.J. Liesegang; 2008
- National Institute of Neurological Disorders and Stroke: Meningitis and Encephalitis Information Page
