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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. There is not always an explanation for why primary headaches occur, and the cause and location of the pain can vary.

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.

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A tension headache may last between half an hour to several days.

Tension or tension-type headaches (TTH) are 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 TTH are:

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

Treatment

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

When they occur more frequently, alternative treatments may help to reduce how often and how long they occur for.

Treatment options include:

Causes and prevention

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

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

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A migraine may cause sensitivity to light and visual disturbances.

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

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

Common symptoms 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, in which the person experiences flashing lights or other visual disturbances.

Triggers

A variety of factors that are specific to each person might trigger migraines.

These factors may be emotional, physical, environmental, dietary, or relate to medication and include:

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

Causes and treatment

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

The treatment of migraines should involve analgesics, such as aspirin or acetaminophen, and resting 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 the changes in the brain that cause migraines.

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

Prevention

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

  • medication used for epilepsy, depression, and high blood pressure
  • stress management, exercise, relaxation, and physical therapy
  • noting down and avoiding personal triggers, including avoiding certain foods
  • hormone therapy

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

Occasional use of pain relief does not cause any problems. However, when a person take pain relief medication headaches more than two or three times a week over an extended period, a MOH 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:

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

Treatment

The best treatment for MOH is often to stop taking pain relief medication entirely. Headaches will become worse at first but will quickly resolve. A person can then continue 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 is dangerous.

Prevention

To prevent MOH, 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.

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Physical therapy or massages may help to treat mild to moderate occipital neuralgia.

Occipital neuralgia (ON) is a distinctive 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 the symptoms, a person or medical professional might mistake ON for a migraine or another type of headache. A distinguishing feature of ON is pain after applying pressure to the back of the neck and scalp.

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

As ON 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 ON may need to take oral muscle relaxants or nerve blocking medications. For extreme pain, local anesthetic or steroid injections are used.

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

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 weight lifting or running to sexual intercourse and straining on the toilet.

Symptoms include a pulsating pain on both sides of 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 to 6 months. Methods for preventing them recurring 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.