The Woman Who Scratched Through Her Skull

The woman known only as “M” has had a rough life. After her marriage fell apart, she lost her kids, became a junkie, contracted HIV, and developed a terrible case of shingles. But nothing compared to the “itch.” Two years after kicking her heroin habit and getting a handle on her disease, the right side of her head started inexplicably itching like crazy.

It began after a nasty shingles attack, and when she sought help, the doctors were baffled. She had no parasites, rashes, or red marks. No creams helped, and M couldn’t stop scratching. The itchiness was constant and especially unbearable at night. She sometimes scratched so hard that she woke up to find her pillow caked with blood. She tried wearing caps to bed, but nothing could stop her from scratching her head.

One night, M woke up to find green liquid dripping down her face. Alarmed, she visited her doctor, and after a quick glance, her physician called for an ambulance. M was rushed to Massachusetts General Hospital, where she was told she needed surgery immediately. It turned out that, during the night, M had scratched straight through her skull, digging down to the brain. It seems impossible for fingernails to claw through bone on their own, but because of an infection called osteomyelitis, M’s skull was soft enough that she was able to dig a hole in her head.

Still, the itching remained. M tore off two skin grafts in her desperate attempt to kill the itch and had to be restrained. Doctors put a foam helmet on her head, tied her hands to the bed at night, and kept her locked up in a medical ward for two years. All this time, experts were still unsure what was causing M’s condition. Some surmised that since her shingles had destroyed 96 percent of M’s nerve fibers in the right side of her scalp, perhaps the remaining 4 percent of nerves were active itch fibers. However, when they snipped the main sensory nerve leading to the front of her head, nothing changed. The itch kept on itching.

If nerve fibers aren’t to blame, what’s going on? Science writer and surgeon Atul Gawande believes M’s brain is very confused. Since most of the nerve fibers are gone from the front of M’s head, the brain isn’t sure what’s really going on in that region, and for some reason, it’s decided she must be itchy. Since there aren’t any nerves to contradict the official story, the itching goes on and on. It’s a horrible scenario similar to the suffering of amputees with phantom limbs whose invisible appendages sometimes contort into uncomfortable positions.

Sadly, M has never been cured of her hellish itch. Today, she’s wheelchair-bound because the left side of her body is partially paralyzed. The itch is still there, and while she has overcome her nighttime compulsion to scrape her scalp, she keeps her nails very short, just in case.