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A headache can be either the main reason for pain or a secondary symptom of problems in another part of the body. Some headache symptoms occur specifically in the back of the head.

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This article looks at five of the most common causes of pain in the back of the head:

  • tension-type headaches
  • migraine
  • medication overuse headaches
  • occipital neuralgia
  • exercise-induced headaches

We also take a look at their symptoms, possible treatments, and prevention methods.

Tension or tension-type headaches (TTH) usually cause forehead pain, but they are also the most common cause of pain in the back of the head. They can last for up to 7 days, but they can also be brief, lasting for as little as 30 minutes.

The symptoms of a tension-type headache are:

  • a feeling of tightening around the back or front of the head
  • pain that is mild to moderate but occasionally severe
  • the headache is not made worse by exercise
  • no nausea or vomiting

Treatment

Taking pain relief such as aspirin or acetaminophen is usually enough if tension headaches are infrequent.

When they occur more often, lifestyle modification and/or alternative treatments may help reduce their frequency and length.

Treatment options include:

Causes and prevention

The cause of TTH is not currently known, but several factors are potential triggers. These include:

  • stress
  • fatigue
  • lack of sleep
  • missing meals
  • poor posture
  • arthritis
  • sinus pain
  • not drinking enough water

Learn more here about tension headaches.

Migraine headaches are a common type of recurring headache that often start during childhood and increase in frequency and severity with age.

In adulthood, they can occur several times a week, especially in females between the ages of 35 and 45 years.

Common symptoms of migraine include:

  • throbbing intense pain on one side of the head
  • nausea and vomiting
  • visual disturbance
  • heightened sensitivity to light, noise, and smell
  • muscles tenderness and sensitive skin
  • last from a few hours to several days
  • physical activity makes them worse

An “aura” might precede a migraine headache, in which the person experiences flashing lights or other visual disturbances.

Triggers

A variety of factors specific to each person might trigger migraine episodes.

These factors may be emotional, physical, environmental, dietary, or medication-related, and include:

  • stress
  • menstrual or other hormone changes
  • anxiety or depression
  • flashing and bright lights, loud noises, or strong smells
  • lack of food
  • inadequate sleep
  • certain food types, such as cheese, chocolate, and caffeine
  • taking a contraceptive pill

Causes and treatment

Inflammatory substances that trigger pain sensors in the blood vessels and nerves of the head might cause migraine.

To treat migraine a person should take analgesics, such as aspirin or acetaminophen, and rest in a darkened room.

If normal analgesics do not work, then a doctor might prescribe antimigraine drugs known as triptans. These drugs cause blood vessels to shrink and contract, which reverses some of the changes in the brain that cause migraine.

The sooner a person receives treatment for a migraine epsiode, the more effective that treatment will be.

Prevention

People can take certain steps to reduce the risk of migraine. These steps include:

  • medications specifically approved for migraine prevention
  • prevention with medication that is usually used for epilepsy, depression, or high blood pressure
  • stress management, exercise, relaxation, and physical therapy
  • noting down and avoiding personal triggers, including avoiding certain foods
  • hormone therapy

Find out more about migraine, how it differs from headache, and the treatment options.

Medication-overuse headaches (MOH) may develop if a person uses too much pain relief medication. MOH headaches are also known as rebound headaches.

Occasional use of pain relief does not cause any problems. However, when a person takes pain relief medication more than two or more days a week over an extended period, a medication overuse or rebound headache can occur.

The main symptoms include:

  • persistent, almost daily headaches
  • worse pain when waking
  • a headache after stopping pain relief

Other problems associated with MOH are:

  • sleepiness
  • nausea
  • anxiety
  • irritability
  • lack of energy
  • physical weakness
  • restlessness
  • difficulty concentrating
  • depression

Treatment

The best treatment for a medication overuse headache is often to taper or stop taking pain relief medication entirely. Headaches will become worse at first but will quickly resolve. A person can then resume taking their normal or preferred pain relief medication.

In more severe cases, people should see a doctor. An individual may need physical or behavioral therapy to break the cycle of using pain relief.

For certain medications, such as opioids, a doctor will need to recommend a gradual reduction in dosage, as instantly stopping some medications could be dangerous.

Prevention

To prevent a medication overuse headache, people should avoid using pain relief medication for headaches more than a couple of times per week. If headaches requiring pain medication are persistent and frequent, seek advice from a doctor for better prevention and treatment.

Occipital neuralgia is a distinctive and less common type of headache that tends to begin at the base of the neck and spreads up to the back of the head, then behind the ears.

It may relate to damage or irritation of the occipital nerves, which run up the back of the neck to the base of the scalp.

Underlying diseases, neck tension, or other unknown factors might cause the damage or irritation.

The pain in occipital neuralgia can be severe. Other symptoms include:

  • continuous throbbing and burning ache
  • intermittent shocking or shooting pains
  • pain is often on one side of the head and can be triggered by moving the neck
  • tenderness in the scalp
  • sensitivity to light

Diagnosis

Due to the similarity of symptoms, a person or medical professional might mistake occipital neuralgia for a migraine headache or another type of headache. A distinguishing feature of occipital neuralgia is pain after applying pressure to the back of the neck and scalp.

Sometimes, a doctor may diagnose occipital neuralgia by injecting a local anesthetic close to the occipital nerves, providing a temporary nerve block. If the pain decreases, then a doctor will likely diagnose occipital neuralgia.

As occipital neuralgia can be a symptom of other disorders, the doctor may also check for other underlying conditions.

Causes

Possible causes include:

  • damage to the spine or discs
  • osteoarthritis
  • tumors
  • gout
  • nerve damage caused by diabetes
  • inflammation of blood vessels
  • infection

Treatment

Applying heat packs, resting, massage, physical therapy, and taking anti-inflammatory medications, such as aspirin or naproxen, can help reduce pain levels. Various types of heat packs are available online.

If pain is severe, a person with occipital neuralgia may need to take oral muscle relaxants or nerve-blocking medications. For severe pain, a medical professional may recommend a local anesthetic or steroid injections.

On rare occasions, a person may need surgery to reduce pressure on the nerves or block pain messages to this part of the body.

What is occipital neuralgia and what are the treatment options? Find out more here.

Exercise-induced headaches occur as the result of strenuous physical activity. They start suddenly during or immediately after exercise, rapidly becoming severe.

A wide range of exercises might trigger this pain, from weightlifting or running to sexual intercourse and straining on the toilet.

Symptoms include a pulsating pain on both sides of the head, which can last from 5 minutes to 2 days. These headaches are usually isolated events and may also produce migraine-like symptoms.

Causes and prevention

The cause of these headaches is unknown. They typically only occur for 3–6 months. Methods for preventing them from recuring include:

  • taking pain relief medication before exercise
  • avoiding strenuous activity
  • warming up properly
  • drinking enough fluids
  • eating nutritious foods
  • getting enough sleep

Treatment consists of using normal headache pain relief medication, such as aspirin or acetaminophen.

How can exercise cause a headache?

Headaches are common. They can affect a person’s quality of life and their ability to carry out everyday tasks.

Many headaches go away without treatment, but some have more serious causes. Anyone who is worried about pain in the back of their head should seek medical advice. If there is an underlying cause that needs addressing, it is better to do so as soon as possible.