Occipital Neuralgia

If you have recurring pain at the back of your head or neck, you might have occipital neuralgia. This painful nerve condition causes severe, piercing headaches.

The condition isn’t life-threatening but it can affect sleep, work and daily activities. Getting the right diagnosis is important because treatments for occipital neuralgia are different from treatments for migraines or other headaches.

At Banner Health, our neurology, pain management and rehabilitation specialists work together to find the cause of your pain and make a treatment plan tailored to your needs and goals. Together, we’ll help you find ways to reduce your pain and improve your quality of life.

What is occipital neuralgia?

Occipital neuralgia is a painful condition that occurs when the occipital nerves that run from the top of your spine to your scalp are compressed or irritated.

Three occipital nerves run up each side of your scalp, sending messages to your brain:

• The greater occipital nerve
• The lesser occipital nerve
• The third occipital nerve

When one or more of these nerves become irritated, compressed or inflamed, it can send pain signals to the brain even when there isn’t an injury to your head. This causes sudden episodes of severe pain that many people mistake for migraines or other headache disorders.

What are the symptoms of occipital neuralgia?

If you have occipital neuralgia, you might experience one or more of these symptoms:

• Sharp, stabbing or electric shock-like pain in the back of the head
• Pain that starts at the base of the skull and travels upward
• Burning, aching or throbbing pain between episodes
• Pain on one or both sides of the head
• Upper neck pain or stiffness
• Scalp tenderness or sensitivity
• Pain when brushing your hair, washing your hair or resting your head on a pillow
• Pain triggered by turning your neck or certain head movements
• Pain behind one eye

The pain often comes in sudden bursts that last from a few seconds to minutes. Some people experience repeated attacks throughout the day, while others have lingering soreness between episodes.

What causes occipital neuralgia?

Occipital neuralgia develops when one or more occipital nerves become irritated, inflamed or compressed. Sometimes the cause is clear but, in many cases, no specific cause can be found.

Possible causes include:

• Neck injuries or trauma
• Whiplash from a car accident or sports injury
• Tight muscles in the neck and shoulders
• Poor posture or spending long hours looking down at a computer or phone
• Arthritis in the upper neck
• Pinched nerves in the cervical spine
• Prior surgery or injury involving the neck or scalp
• Diabetes or other conditions that affect nerves
• Inflammation around the nerves
• Tumors or other growths that put pressure on the nerve (rare)

You may be more likely to develop occipital neuralgia if you have chronic neck pain, arthritis, degenerative disk disease or a job or hobby that requires repetitive neck movements or prolonged poor posture.

Often, occipital neuralgia develops without an obvious cause. Even when no clear reason is identified, treatment can often help reduce pain and improve daily function.

Occipital neuralgia vs. migraines and other headaches

Occipital neuralgia can feel like a migraine or another type of headache, and people can have both occipital neuralgia and migraine at the same time. However, the cause and symptoms are different.

Migraines

Migraines usually cause throbbing or pulsing pain, often on one side of the head. They may also cause nausea, vomiting and sensitivity to light, sound or smells. Irritated nerves in the back of the head do not directly cause migraines. Occipital neuralgia and migraine often occur together, and irritated occipital nerves may trigger migraines in some people. Treating occipital neuralgia can sometimes reduce migraine attacks.

Other headaches

Tension headaches often feel like pressure or a tight band around the head, lasting hours. Cluster headaches cause pain near one eye. Occipital neuralgia pain is more likely to be intense and brief, in the back of the head, and triggered by touch, movement or pressure on the scalp or neck.

Other conditions that may be confused with occipital neuralgia

In addition to migraines and other headaches, symptoms of occipital neuralgia can also be confused with:

• Trigeminal neuralgia
• Neck arthritis
• Pinched nerve in the neck
• Muscle strain
• Shingles or postherpetic neuralgia
• Temporal arteritis in older adults
• Infection or inflammation

How is occipital neuralgia diagnosed?

There is no single test that can confirm occipital neuralgia. Diagnosis typically starts with a physical and neurological exam. Your health care provider will ask questions about where your pain starts, what it feels like and what triggers it. They will check for tenderness, signs of nerve irritation and test your neck movement and muscle strength.

Your provider may also recommend diagnostic imaging tests (such as MRI and CT scans) and nerve blocks to find out if pain comes from your occipital nerve.

Treatment options for occipital neuralgia

Treatment focuses on reducing nerve irritation, controlling pain and improving your quality of life. Your treatment plan depends on your symptoms, how long you have had pain and what is causing your condition.

Nonsurgical treatments

Most people begin with nonsurgical treatments to help reduce pain and inflammation. These treatments include:

• Medications: Antidepressants such as amitriptyline and duloxetine; anticonvulsants such as gabapentin; nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen; and muscle relaxers to relieve pain.
• Heat therapy: Heating pads on the scalp or where the pain is felt most.
• Physical therapy: A physical therapist may recommend neck and shoulder stretches, strengthening exercises, posture training and other movement to improve strength and flexibility.
• Injections: Nerve blocks with a local anesthetic and sometimes a steroid can be both diagnostic and therapeutic. Botox can help by reducing irritation from tight muscles but may not be covered by insurance.
• Radiofrequency ablation: Uses heat energy to interrupt pain signals from the affected nerve. This minimally invasive treatment may help some people.

Surgical treatment for occipital neuralgia

Surgery is not the first treatment for occipital neuralgia. It may be considered for people with severe, ongoing pain that does not improve with medicines, injections or other nonsurgical treatments.

Surgical options include:

• Nerve decompression surgery: A surgeon removes or adjusts tissue that presses on or irritates the nerve.
• Occipital nerve stimulation: A surgeon places a small device under the skin to send gentle electrical signals to the nerves. These signals can help reduce pain messages to the brain.

Living with occipital neuralgia

Occipital neuralgia can affect your comfort, sleep and daily activities. Managing triggers and protecting your neck can help reduce symptoms. With the right treatment plan, many people can reduce pain and enjoy their usual activities.

You may find relief by:

• Sitting or using a computer with good posture
• Taking breaks from activities that strain your neck
• Applying heat or cold as your provider recommends
• Stretching your neck and shoulders regularly
• Using relaxation techniques to manage stress
• Tracking your symptoms and triggers

Keeping a pain journal helps you and your provider see patterns. Write down when your pain happens, how long it lasts and what activities make it better or worse.

When should you see a provider for occipital neuralgia?

Contact a health care specialist if you have ongoing or severe pain in the back of your head, neck or scalp, especially if it affects your daily life.

Make an appointment if you experience:

• Repeated sharp head pain
• Pain that starts at the base of your skull and moves upward
• Scalp tenderness that makes brushing your hair or resting your head uncomfortable
• Neck pain with headaches
• Head pain that doesn’t get better with over-the-counter (OTC) treatments
• Headaches that get more frequent or severe

When to seek emergency care

Call 911 or go to the nearest emergency room if you have a sudden, severe headache that is different from your usual pain or occurs with symptoms such as:

• Weakness or numbness on one side of your body
• Trouble speaking
• Confusion
• Loss of vision
• Fever or stiff neck
• Loss of consciousness

Why choose Banner Health for occipital neuralgia care?

Finding the right diagnosis is an important first step in treating occipital neuralgia. At Banner Health, our specialists take the time to understand your symptoms, find the source of your pain and create a treatment plan that fits your needs and goals.

Our team includes experts in neurology, pain management, physical therapy and neurosurgery who work together to provide comprehensive care. From nonsurgical treatments to advanced procedures, we offer several options to help reduce pain and improve your quality of life.

If you have ongoing head or neck pain, Banner Health is here to help you find answers and start feeling better.

Find a Banner specialist.

FAQs

What does occipital neuralgia feel like?

It often causes sharp, stabbing or electric shock-like pain in the back of the head, upper neck or scalp. Some people also feel burning pain or scalp sensitivity.

What causes occipital neuralgia?

It happens when the occipital nerves get irritated or compressed. This can be caused by neck injuries, muscle tension, arthritis, nerve compression or inflammation. Sometimes, the cause is unknown.

Can occipital neuralgia cause headaches?

Yes, it can cause headache-like pain, especially in the back of the head and scalp. Since its symptoms can look like migraines or other headaches, a doctor can help identify the cause.

Is occipital neuralgia permanent?

Not always. Many people get better with treatment but others may have recurring pain that needs ongoing care.

How is occipital neuralgia treated?

Doctors may use medicines, physical therapy, nerve blocks, radiofrequency ablation or sometimes surgery. The right treatment depends on your symptoms and what causes nerve pain.

Can stress make occipital neuralgia worse?

Stress does not directly cause it but it can increase muscle tension in the neck and shoulders, which might make symptoms worse for some people.

When should I see a doctor?

You should visit a doctor if you have repeated sharp pain in the back of your head or neck, pain that affects your daily activities or symptoms that don’t get better with home treatments.