Tenderness on the top of the head is a common symptom of a tension headache, according to the American Academy of Craniofacial Pain. Tension headaches occur as a result of straining muscles or contracting the muscles for extended periods of time.
A scalp that is sore to the touch can also indicate temporal arteritis, a condition in which the blood vessels that carry blood to the head become inflamed. The exact cause of temporal arteritis is not completely understood, however it is believed to be triggered by an abnormal immune response and has been associated with antibiotic use, according to Medline Plus. Additional symptoms include throbbing on one side of the head, pain in the jaw, fever and a general feeling of malaise.
Tenderness on the top of the head and scalp can also be caused by occipital neuralgia, a condition caused by inflammation of the nerves that travel from the spinal cord to the top of the head become inflamed or injured, according to WebMD. Additional symptoms of the condition include throbbing pain that first develops at the base of the head, severe, shocking pain on both sides of the head, light sensitivity and pain behind the eyes. Occipital neuralgia symptoms may be confused with those of a migraine headache. Treatments for the condition depend on the underlying cause of nerve inflammation, but symptoms can be soothed with warm compresses and over-the-counter pain medications.