This article looks at five of the most common causes of pain in the back of the head:
- tension-type headaches
- medication overuse headaches
- occipital neuralgia
- exercise-induced headaches
We also take a look at their symptoms, possible treatments, and prevention methods.
1. Tension-type headaches
A tension headache may last between half an hour to several days.
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
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:
- lack of sleep
- missing meals
- poor posture
- sinus pain
- not drinking enough water
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
Migraines are sometimes preceded by an "aura," where the person experiences flashing lights or other visual disturbances.
Migraines can be triggered by a variety of factors specific to each person. These factors can 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
- contraceptive pill
Causes and treatment
Migraines are thought to be caused by inflammatory substances that trigger pain sensors in the blood vessels and nerves in the head.
Migraines should be treated with analgesics, such as aspirin or acetaminophen, and by resting in a darkened room.
If normal analgesics do not work, then a doctor might prescribe antimigraine drugs known as triptans. Scientists think that these drugs cause blood vessels to shrink and contract, which reverses the changes in the brain that cause migraines.
The sooner an attack is treated, the more effective the treatments are.
There are some steps that people can take to reduce the chances 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
3. Medication-overuse or rebound headache
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 pain relief medication is taken for 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:
- lack of energy
- physical weakness
- difficulty concentrating
- loss of memory
Usually, the best treatment for MOH is to stop taking pain relief medication entirely. Headaches will become worse initially, but they will quickly go away. Normal pain relief use can then be resumed.
In more severe cases, people should see a doctor. Physical and behavioral therapy may be needed to break the cycle of pain relief use.
For certain medications, such as opioids, a doctor will need to recommend a gradual reduction of dose, as instantly stopping some medications is dangerous.
To prevent MOH, 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, a person should seek advice from a doctor.
4. Occipital neuralgia
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 is associated with damage or irritation to the occipital nerves, which run up the back of the neck to the base of the scalp.
The damage or irritation can be caused by underlying diseases, neck tension, or other unknown factors.
The pain caused by 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
Sometimes, a doctor may diagnose ON by injecting local anesthetic close to the occipital nerves, providing a temporary nerve block. If pain is relieved, 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.
Known possible causes include:
- damage to the spine or discs
- nerve damage caused by diabetes
- inflammation of blood vessels
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, oral muscle relaxants or nerve blocking medications may be required. For extreme pain, local anesthetic or steroid injections are used.
On rare occasions, surgery may be required to reduce the pressure on the nerves or block pain messages to this part of the body.
5. Exercise-induced headaches
Exercise-induced headaches are associated with strenuous physical activity. They start suddenly during or immediately after exercise, rapidly becoming severe.
A wide range of exercises can 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 to prevent 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.
If someone has a severe headache, they are not alone. Around 50 percent of adults worldwide have at least one severe headache every year. They can be painful and disabling when they occur.
Headaches are extremely common, and many are just a pain in the head that goes away on its own. Some may have more serious causes, however.
Anyone who is worried about pain in the back of their head should always seek medical advice from a doctor.