Burning vertex syndrome: Clinical, MRI and biochemical correlates in an Indian Cohort

Background: Burning Vertex Syndrome (BVS) is a dysesthetic condition, a new headache type, characterized by persistent or episodic burning sensation over the vertex of the scalp with or without associated symtpoms like photophobia or phonophobia or nausea or any other autonomic symptoms. Due to unclear etiology and limited clinical data, patients often undergo extensive investigations with delayed diagnosis. Understanding clinical, radiological, and biochemical associations is essential for accurate evaluation and management.Aim and Objective: To study the clinical profile, MRI brain findings, and serum biochemical parameters in patients presenting with Burning Vertex Syndrome.Materials and Methods: A cross-sectional observational study was conducted on 100 consecutive patients presenting with vertex scalp burning for more than four weeks. Detailed demographic data, sleep status, psychological stressors, and local scalp examination findings were recorded. All patients underwent MRI brain imaging and serum investigations including hemoglobin, serum iron, thyroid-stimulating hormone, and vitamin B12 levels. Data were analyzed using descriptive statistics.Results: Females constituted 80% of the study population, with maximum patients in the 30–50-year age group (70%). MRI brain was normal in 65% of cases. Chronic small vessel ischemic disease was observed in 21%, and CSVID with generalized cortical atrophy in 12%. Cerebral venous sinus thrombosis and meningioma were detected in 1% each. Anemia and low serum iron were found in 10% of patients, while vitamin B12 deficiency and hypothyroidism were present in 5% each. Sleep disturbance and psychological stress were reported by 80% and 75% of patients respectively. Local scalp pathology was noted in only 5%.Conclusion: Burning Vertex Syndrome predominantly affects middle-aged females and is strongly associated with sleep disturbance and psychological stress. Although MRI is normal in most cases, microvascular ischemic changes are common radiological findings. Routine neuroimaging and metabolic screening are recommended to exclude secondary causes and guide multidisciplinary management.