If the headline alone doesn't have you feeling a little itchy, you do not have a healthy fear of the mighty bed bug. Bed bugs are an alarmingly common problem in big cities (and hotels).

Maybe that's because you don't live in a city that made Orkin's annual list of the most bed bug-infested cities. This year's list has changes from last year and, despite the common association, it's not Los Angeles or New York climbing up the ranks. The pest-control company creates the annual list using data from "the metro areas where Orkin performed the most bed bug treatments from" December 2018 through November 2019. Those treatments include both residential and commercial properties where the little pests are attempting to make human lives miserable.

Last year's bed bug champion, Baltimore, has fallen to second place while the nation's capital is now the most vermin-filled locale in the country. Washington, DC unseated Baltimore after it sat atop the Orkin list for three straight years. Among the top-50 cities, Flint, Michigan was the biggest climber, rising 16 spots to number 31. At the end of the spectrum, Houston dropped 12 spots to number 38.

Here are the top 20 most bed bug-infested cities, according to Orkin. (The number in parenthesis is the change from the city's place on the list last year.)

1. Washington, DC (+1)

2. Baltimore (-1)

3. Chicago

4. Los Angeles

5. Columbus

6. New York City

7. Detroit (+1)

8. Cincinnati (-1)

9. Indianapolis (+5)

10. Atlanta (-1)

11. Cleveland

12. Philadelphia (-2)

13. San Francisco (-1)

14. Raleigh (-1)

15. Norfolk (+2)

16. Champaign (+7)

17. Dallas (-2)

18. Grand Rapids (+2)

19. Pittsburgh (+6)

20. Charlotte (-1)

While bed bugs have not been found to transmit any diseases to humans, they can be an elusive threat to households," said Chelle Hartzer, an Orkin entomologist, transmitting unpleasant news in a statement. "They are excellent hitchhikers, and they reproduce quickly which makes it nearly impossible to prevent bed bugs. Sanitation has nothing to do with where you’ll find them."

Of course, if you've got them, you can seek professional assistance, but many people try to get rid of bed bugs themselves. It's not impossible, but there's no cure for bed bug-induced nightmares. Sorry.