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These factors may be emotional, physical, environmental, dietary, or medication-related, and include:
Occipital neuralgia is a condition in which the nerves that run from the top of the spinal cord up through the scalp, called the occipital nerves, are inflamed or injured. You might feel pain in the back of your head or the base of your skull.
People can confuse it with a migraine or other types of headache, because the symptoms can be similar. But treatments for those conditions are very different, so it’s important to see your doctor to get the right diagnosis.
Occipital neuralgia can cause intense pain that feels like a sharp, jabbing, electric shock in the back of the head and neck. Other symptoms include:
- Aching, burning, and throbbing pain that typically starts at the base of the head and goes to the scalp
- Pain on one or both sides of the head
- Pain behind the eye
- Sensitivity to light
- Tender scalp
- Pain when you move your neck
Occipital neuralgia happens when there’s pressure or irritation to your occipital nerves, maybe because of an injury, tight muscles that entrap the nerves, or inflammation. Many times, doctors can’t find a cause for it.
Some medical conditions are linked to it, including:
- Trauma to the back of the head
- Neck tension or tight neck muscles
- Tumors in the neck
- Cervical disc disease
- Blood vessel inflammation
How It’s Diagnosed
Your doctor will ask you questions about your medical history and about any injuries you’ve had. They’ll do a physical exam, too. They’ll press firmly around the back of your head to see if they can reproduce your pain.
They may also give you a shot to numb the nerve, called a nerve block, to see if it gives you relief. If it works, occipital neuralgia is likely the cause of the pain. You might also have blood tests or an MRI scan if your doctor thinks your case isn’t typical.
You have to get the right diagnosis to get the right treatment. For example, if you have occipital neuralgia and you get a prescription for migraine medication, you may not get relief.
The first thing you’ll want to do is to relieve your pain. You can try to:
- Apply heat to your neck.
- Rest in a quiet room.
- Massage tight and painful neck muscles.
- Take over-the-counter anti-inflammatory drugs, like naproxen or ibuprofen.
If those don’t help, your doctor may prescribe medications for you, including:
- Prescription muscle relaxants
- Antiseizure drugs, such as carbamazepine (Tegretol) and gabapentin (Neurontin)
- Nerve blocks and steroid shots. The nerve block that your doctor might do to diagnose your condition can be a short-term treatment, too. It may take two to three shots over several weeks to get control of your pain. It’s not uncommon for the problem to return at some point and to need another series of injections.
An operation is rare, but it might be an option if your pain doesn’t get better with other treatments or comes back. Surgery may include:
- Microvascular decompression. Your doctor may be able to relieve pain by finding and adjusting blood vessels that may be compressing your nerve.
- Occipital nerve stimulation. Your doctor uses a device called a neurostimulator to deliver electrical pulses to your occipital nerves. They can help block pain messages to the brain.
Occipital neuralgia is not a life-threatening condition. Most people get good pain relief by resting and taking medication. But if you still hurt, tell your doctor. They’ll want to see if there’s another problem that’s causing your pain.
National Institute of Neurological Disorders and Stroke: “NINDS Occipital Neuralgia Information Page.”
American Association of Neurological Surgeons: “Occipital Neuralgia.”
Jan Brandes, MD, director, Nashville Neuroscience Group at St. Thomas Health Services; assistant clinical professor, Vanderbilt University, Nashville, Tenn.
What is this pain in the back of my head?
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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.
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.
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
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:
- relaxation techniques
- cognitive behavioral therapy
- physical therapy
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
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.
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:
- 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.
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
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.
- 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
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.
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
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.
- 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, 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.
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.
What’s causing the pain in the back of my head at the base of my skull?
The area in the back of your head where the base of your skull meets your neck is a common area to experience pain. In fact, there are many issues that can cause pain there.
In general, neck pain is a common problem in the U.S. Medical researchers report that 5.8% of U.S. women and 4% of U.S. men are experiencing neck pain at any given time . Diagnosing the cause of the pain in the back of your head at the base of your skull is something a physical therapist can do. These specialists can also offer effective treatment for your neck and head pain .
Three common causes of pain in the back of the head at the base of the skull
The area at the back of your head and at the base of your skull is called the occipital region . Often, problems in the neck cause pain to radiate into this region of your head. A few of the issues that commonly trigger pain in the occipital region include:
- Suboccipital muscle tension — The suboccipital muscles connect the top of your neck to the base of your skull. Craning your head forward for long periods of time can leave these muscles tense and sore. The pain can also travel into the back of your head and down your neck.
- Herniated cervical discs — Spinal discs help separate and cushion your vertebrae. This includes the vertebrae in your cervical spine or neck. Trauma or repetitive strain can cause damage to the outer covering of a disc at the top of your neck. As a result, the disc’s inner material can poke out or herniate. This can irritate and inflame soft tissue and nerves near the herniated disc .
- Occipital neuralgia — This nerve condition occurs when the occipital nerves that run through your scalp are irritated or damaged. Occipital neuralgia is often caused by muscle or nerve problems in your neck. The most common symptom of this issue is burning or shocking pains that run from the base of the skull into one or both sides of the head.
How can physical therapy treat the pain in your occipital region?
Identifying the cause of the pain in the back of your head at the base of your skull isn’t the only thing physical therapists can do. They can also treat your pain. Your therapist will use an extensive knowledge of the human musculoskeletal system to develop a treatment plan for you. Such a plan may include therapy techniques like:
- Myofascial release
- Aquatic therapy
- Soft tissue mobilization
- Therapeutic exercises
- Ergonomic training
- Instrument-assisted soft tissue mobilization (IASTM)
- Dry needling
Find help for the pain in the back of your head at the base of your skull at Peak Performance
Struggling with pain in the back of your head at the base of your skull? Our Peak Performance team is primed to help you treat the pain in your occipital region. We can pinpoint the cause of your pain by doing a free screening of your neck and head. You’ll also find that our physical therapists excel at building personalized therapy plans designed to reduce pain. Our team even offers virtual therapy sessions that allow you to treat your pain from home.
Contact us today for more information about how we can address your neck and head pain or to schedule your initial appointment.