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.
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.
Occipital neuralgia differs from other types of headache in the:
- 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 from the spine to the scalp, up each side of the head. Sensitivity can develop anywhere along this route.
Other causes of headache include:
- a sinus infection
- high blood pressure
- the use of certain medications
Some of these types and causes overlap with occipital neuralgia. One expert points out that it is rare to experience only occipital head pain.
Occipital neuralgia may also play a role in unremitting head and neck pain (UHNP), according to some researchers. A doctor may diagnose UHNP if a person experiences head and neck pain for 15 days or more per month.
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 of the occipital nerves becomes irritated, inflamed, or trapped.
A number of factors can cause this. The sections below will outline these in more detail.
Injuries to the neck area, such as whiplash, can damage the nerves and lead to occipital pain.
Tight muscles in the neck and the back of the head can sometimes squeeze, pinch, or trap the occipital nerves, leading to occipital neuralgia.
Secondary occipital neuralgia can develop as a complication of the following:
- osteoarthritis of the neck
- nerve compression in the cervical spine, due to degenerative disk disease, for example
- a tumor
- inflammation of the blood vessels
It may not be possible to identify a single factor to explain occipital head pain.
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 the pain 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:
- applying warm compresses
- trying massage therapy
- taking over-the-counter (OTC) anti-inflammatory medications
- seeking physical therapy
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:
- anesthetic drugs, such as a nerve block
- botulinum toxin (Botox)
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.
If pain is severe and persistently affects a person’s quality of life, the doctor may suggest surgery.
- Occipital nerve stimulation: A surgeon will place electrodes under the skin, near the occipital nerves. This is a minimally invasive procedure and 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 will make a small cut in the back of the neck and releases the nerves from tissues that are compressing them.
In severe cases that have not responded to other treatments, a surgeon may cut the greater occipital nerve. However, this will lead to scalp numbness.
Some exercises can help, especially if poor posture is contributing to occipital neuralgia.
For example, chin tucks can help stretch and strengthen the neck muscles and other tissues. To do chin tucks:
- Stand with the feet shoulder-width apart, with the back against a wall.
- Tuck the chin down, then pull the head back until it touches the wall.
- Hold this position for 5 seconds.
When pulling the head back, keep the chin in a straight line, without lifting or tipping it. Do not continue if the exercise is painful.
Home remedies that may help include:
- 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
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. If the problem persists or recurs, however, a doctor may recommend injections or possibly surgery.