Scalp pruritus is a common complaint in dermatotrichological practice and has a significant impact on the patient’s quality of life. Though the condition is associated with many underlying conditions, determining the proper cause of the symptom is sometimes a great challenge. There is a wide range of its potential causes, which can be attributed to the skin, neurological, systemic, or mental nature. Weighted evaluation and medical examination of the patient will help to avoid misdiagnosis. This chapter will provide a systematic overview of the clinical features of various etiologies’ most common causes of scalp pruritus that should be considered in a systematic approach to evaluating this condition, as well as useful diagnostic and therapeutic tools for patient management.