Occipital neuralgia is a type of headache. It starts in the upper neck or back of the head and can radiate behind the eyes and over the scalp. Damage to the occipital nerves may cause occipital headaches.

This is a specific type of headache but can have symptoms similar to other types. It often affects people with migraine.

Occipital neuralgia results from irritation, inflammation, or injury to the occipital nerves, which run through the scalp. It involves sudden bursts of pain, with or without an ongoing headache.

In this article, learn what causes occipital neuralgia, how to recognize it, and what to do if it happens.

Headaches that occur due to occipital neuralgia can be very painful. The condition involves a sudden but intermittent piercing, shooting, or shock-like pain. This may last from a few seconds to several minutes.

There may also be a persistent throbbing, burning, or aching pain that continues between the spasms.

The pain often spreads or shoots up from where the neck meets the skull, and it may affect:

  • the top of the neck
  • the back of the head
  • behind the ears
  • one side of the head
  • the scalp, especially where the occipital nerves connect
  • behind the eye on the affected side

There may also be:

  • sensitivity to light
  • soreness and sensitivity to the touch
  • bursts of pain that come and go, lasting for a few seconds or minutes
  • a lingering ache between more severe bouts of pain

Small movements can trigger or worsen a burst of pain. These might include:

  • turning the head to one side
  • laying the head down on a pillow
  • brushing or washing the hair

The pain can be intense. Some people say that it feels like a migraine or cluster headache, even though these are different types and require different treatments.

Occipital neuralgia can develop when one or more occipital nerves become irritated, inflamed, or trapped.

Several factors can cause this. The sections below will outline these in more detail.

Injury

Injuries to the neck area or back of the head, such as whiplash, can damage the nerves and lead to occipital pain.

Muscular problems

Tight muscles in the neck and the back of the head can sometimes squeeze, pinch, or trap the occipital nerves, leading to occipital neuralgia.

Other conditions

Secondary occipital neuralgia can develop as a complication of the following:

Identifying a single factor to explain occipital head pain may not be possible.

Occipital neuralgia differs from other types of headaches in the:

  • cause
  • areas of pain
  • type of pain

It results from irritation or injury to the occipital nerves. There are three occipital nerves — the greater, the lesser, and the third — present in the second and third vertebrae of the neck.

The nerves run up each side of the head from the spine to the scalp. Sensitivity can develop anywhere along this route.

Other causes of headache include:

Some of these types and causes overlap with occipital neuralgia. One expert points out that it is rare to experience only occipital head pain.

Some researchers believe occipital neuralgia may also contribute to unremitting head and neck pain (UHNP). A doctor may diagnose UHNP if a person experiences headaches for 15 days or more monthly.

Learn more about different types of headaches here.

It is not always easy to diagnose occipital neuralgia, as it can share symptoms with other types of headache, including migraine.

A doctor will start by asking about the person’s symptoms. For example, they may ask how severe the pain is, how often it occurs, where the person feels it, and their possible triggers.

They may also:

  • take a medical history
  • conduct a physical examination
  • perform an ultrasound scan
  • recommend other scans or tests to rule out other possible causes

During a physical exam, the doctor may gently press on the areas where the occipital nerves run to see if the pressure generates any pain.

The doctor may also inject a nerve block to confirm the diagnosis. If the pain resolves after this, it may indicate that occipital neuralgia was the cause.

The following options may help a person manage the pain and discomfort associated with occipital neuralgia:

These options can relieve pain or help relax and release the muscles that are putting pressure on the occipital nerves.

Many people with occipital neuralgia also have migraine. In some cases, treating the migraine may improve the symptoms of occipital head pain.

Prescription drugs and injections

If home remedies and OTC treatments do not help, a doctor may prescribe:

  • muscle relaxants
  • injections into the vertebrae
  • trigger point injections

Injections may help reduce inflammation, pain, or both.

Some examples of injectable drugs include:

However, injecting drugs into the vertebrae is a relatively invasive procedure. A doctor will usually recommend this treatment only if others have not worked.

Also, these injections will not cure neuralgia, and the pain may return a few months later.

Surgery

If severe pain persistently affects a person’s quality of life, the doctor may suggest surgery.

Types include:

  • Occipital nerve stimulation: A surgeon will place electrodes under the skin near the occipital nerves. This minimally invasive procedure does not damage the nerves. It works by using electrical impulses to block pain messages.
  • Spinal cord stimulation: The surgeon will place the electrodes between the spinal cord and the vertebrae.
  • C2,3 ganglionectomy: This procedure disrupts a cluster of nerves that contribute to occipital head pain.
  • Occipital release surgery: The surgeon makes a small cut in the back of the neck and releases the nerves from tissues, compressing them.

In severe cases that have not responded to other treatments, a surgeon may cut the greater occipital nerve. However, this may lead to scalp numbness.

Some exercises can help, especially if posture contributes to occipital neuralgia.

For example, chin tucks can help stretch and strengthen the neck muscles and other tissues. To do chin tucks:

  1. Stand with the feet shoulder-width apart, with the back against a wall.
  2. Tuck the chin down, then pull the head back until it touches the wall.
  3. Hold this position for 5 seconds.

Keep the chin straight when pulling the head back without lifting or tipping it. Do not continue if the exercise is painful.

Home remedies that may help include:

  • resting
  • massaging the base of the skull with the fingertips
  • applying warm compresses for up to 20 minutes
  • performing exercises such as chin tucks

A physical therapist can provide specific exercises to help manage pain or prevent a recurrence.

There are a few options that may help prevent occipital neuralgia. These include anti-seizure medications and tricyclic antidepressants.

Lifestyle remedies that may help include:

  • getting regular exercise, such as stretching or yoga
  • seeking advice on posture
  • avoiding keeping the head in a downward and forward position for a long time

What triggers occipital neuralgia?

Triggers can include injury, conditions such as osteoporosis, muscular issues, or movements such as turning the head to one side or brushing hair.

What are the trigger points for occipital neuralgia?

Trigger points may include suboccipital muscles that induce pain, particularly when doing head movements.

What happens if occipital neuralgia goes untreated?

Occipital neuralgia is not fatal, but without treatment, the pain may not subside.

How can a person release the occipital nerve?

Treatments for releasing the occipital nerve include massage therapy or applying heat on the location of pain.

Occipital neuralgia is a type of nerve pain that can lead to headaches. It can occur when there is pressure or damage to the occipital nerves. These start in the neck and run up the sides of the head.

In most cases, the pain will improve with home remedies or medication. However, if the problem persists or recurs, a doctor may recommend injections or surgery.