Occipital Neuralgia

What is Occipital Neuralgia

Occipital neuralgia is a type of headache that causes brief episodes of very bad pain in the back of your head. Pain from occipital neuralgia may spread (radiate) to other parts of your head.

These headaches may be caused by irritation of the nerves that leave your spinal cord high up in your neck, just below the base of your skull (occipital nerves). Your occipital nerves transmit sensations from the back of your head, the top of your head, and the areas behind your ears.

What are the causes?

This condition can occur without any known cause (primary headache syndrome). In other cases, this condition is caused by pressure on or irritation of one of the two occipital nerves. Pressure and irritation may be due to:

  • Muscle spasm in the neck.
  • Neck injury.
  • Wear and tear of the vertebrae in the neck (osteoarthritis).
  • Disease of the disks that separate the vertebrae.
  • Swollen blood vessels that put pressure on the occipital nerves.
  • Infections.
  • Tumors.
  • Diabetes.

What are the signs or symptoms?

This condition causes brief burning, stabbing, electric, shocking, or shooting pain which can radiate to the top of the head. It can happen on one side or both sides of the head. It can also cause:

  • Pain behind the eye.
  • Pain triggered by neck movement or hair brushing.
  • Scalp tenderness.
  • Aching in the back of the head between episodes of very bad pain.
  • Pain gets worse with exposure to bright lights.

How is this diagnosed?

There is no test that diagnoses this condition. Your health care provider may diagnose this condition based on a physical exam and your symptoms. Other tests may be done, such as:

  • Imaging studies of the brain and neck (cervical spine), such as an MRI or CT scan. These look for causes of pinched nerves.
  • Applying pressure to the nerves in the neck to try to re-create the pain.
  • Injection of numbing medicine into the occipital nerve areas to see if pain goes away (diagnostic nerve block).

How is this treated?

Treatment for this condition may begin with simple measures, such as:

  • Rest.
  • Massage.
  • Applying heat or cold on the area.
  • Over-the-counter pain relievers.

If these measures do not work, you may need other treatments, including:

  • Medicines, such as:
    • Prescription-strength anti-inflammatory medicines.
    • Muscle relaxants.
    • Anti-seizure medicines, which can relieve pain.
    • Antidepressants, which can relieve pain.
    • Injected medicines, such as medicines that numb the area (local anesthetic) and steroids.
  • Pulsed radiofrequency ablation. This is when wires are implanted to deliver electrical impulses that block pain signals from the occipital nerve.
  • Surgery to relieve nerve pressure.
  • Physical therapy.

Follow these instructions at home:

Pain management

  • Avoid any activities that cause pain.
  • Rest when you have an attack of pain.
  • Try gentle massage to relieve pain.
  • Try a different pillow or sleeping position.
  • If directed, apply heat to the affected area as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
    • Place a towel between your skin and the heat source.
    • Leave the heat on for 20–30 minutes.
    • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
  • If directed, apply ice to the back of the head and neck area as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times per day.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Avoid things that make your symptoms worse, such as bright lights.
  • Try to stay active. Get regular exercise that does not cause pain. Ask your health care provider to suggest safe exercises for you.
  • Work with a physical therapist to learn stretching exercises you can do at home.
  • Practice good posture.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your medicine is not working.
  • You have new or worsening symptoms.

Get help right away if:

  • You have very bad head pain that does not go away.
  • You have a sudden change in vision, balance, or speech.


  • Occipital neuralgia is a type of headache that causes brief episodes of very bad pain in the back of your head.
  • Pain from occipital neuralgia may spread (radiate) to other parts of your head.
  • Treatment for this condition includes rest, massage, and medicines.

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