Medical News Today: What you need to know about occipital neuralgia

Occipital neuralgia is the term for a headache that starts in the upper neck or back of the head and spreads or radiates behind the eyes, forehead, and up to the scalp.

Headaches are one the world’s most common health problems, with 80-90 percent of Americans experiencing a “tension headache” at some point in their lives.

More painful migraine, cluster, and other headaches are a leading cause of doctor or emergency room visits.

Although headaches are a common health problem, occipital neuralgia is a specific type of headache. According to the American Migraine Foundation, it is also rare, affecting only 3.2 people out of every 100,000 a year.

How is it different from other headaches?

man holding the back of his neck
Occipital neuralgia is a headache that begins in the upper neck or back of head.

Headaches due to occipital neuralgia are frequently quite painful, starting with a sharp, stabbing pain, but most people with this condition respond well to treatment and most recover.

Occipital neuralgia is different from other types of headaches in two ways:

  1. The cause of the condition.
  2. The specific places where individuals feel pain.

Other headaches have more general causes, which can range from sinus infections to high blood pressure to medications and many other potential triggers.

But occipital neuralgia only develops when the occipital nerves are irritated or injured. These nerves are found at the second and third vertebrae of the neck.

Occipital neuralgia pain will only develop in areas touched by the greater, lesser, and third occipital nerves.

With one on each side of the head, the occipital nerves run from the spine to the scalp, and sensitivity can develop anywhere along this route.

What are the main symptoms?

lady touching side of face whilst lying in bed
The pain from occipital neuralgia may spread to the sides of the head or behind the eyes.

For most people, the pain strikes on only one side of the head. It also tends to spread, usually from where the skull meets the neck, and then traveling up the back of the head and to the sides or behind the eyes.

In many individuals, the scalp can be affected, especially where the occipital nerves connect.

It can feel sore or extremely sensitive.

Light may also irritate the eyes.

Occipital neuralgia is described as coming in bursts of pain that come and go, lasting for a few seconds or minutes. At times, individuals may experience a lingering ache between more extreme bouts of pain.

Small movements can trigger an outburst of pain from occipital neuralgia. These movements include:

  • turning the head to the side
  • putting the head down on a pillow
  • brushing or washing the hair

The pain can be quite intense, which can prompt some individuals with the condition to say it is like a migraine or a cluster headache, even though these are different types and require different treatments.

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What causes it?

Different conditions and circumstances can irritate the occipital nerves, which then give rise to occipital neuralgia.


Injuries to the neck area, such as whiplash from a car accident or some other sort of trauma, can damage the occipital nerves and lead to this condition.

Muscular problems

Tight muscles in the neck and the back of the head can put the squeeze on occipital nerves and pinch or entrap them, which can also lead to occipital neuralgia.

Back issues

Problems with the spine, such as arthritis, degenerating discs, or spondylosis, are possible sources of pressure on the occipital nerves, as are tumors.

Other causes

Other conditions that can play a role in developing occipital neuralgia include:

In many cases, it is not possible for someone to identify a single factor that damaged or irritated the occipital nerves.

How is it diagnosed?

doctor examining women's head and neck
During an examination the doctor may see if pressing on the occipital nerve area causes pain.

A doctor taking a medical history and conducting a physical exam diagnoses occipital neuralgia.

This condition causes extreme tenderness along the occipital nerves. So, during a physical exam, the doctor may press on these areas to see if the pressure generates pain.

It is not always easy to diagnose occipital neuralgia because it has similar characteristics to many other kinds of headaches.

After initial exams, a doctor may order more involved tests.

One way to diagnose occipital neuralgia can also provide relief.

If a nerve block injected between the C2 and C3 vertebrae makes the symptoms go away, it is a strong indication of occipital neuralgia.

Deadening the nerves with anesthetics and corticosteroids helps individuals feel better, although the effects are temporary, only lasting about 12 weeks. However, injections into the vertebrae and numbing nerves are involved procedures, so a doctor will often pursue less invasive treatments first.

Can it be prevented?

For some people, antiepileptic medications and tricyclic antidepressants can prevent bouts of pain due to occipital neuralgia.

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Doctors will usually recommend straightforward treatments when individuals are first diagnosed with occipital neuralgia. These include:

The aim is to provide many people with relief by relaxing and releasing the muscles that are putting pressure on the occipital nerves.

Other medications, such as muscle relaxants and anticonvulsants, can help offset symptoms.

Nerve blockers

Nerve-blocking injections, which are used to diagnose the condition, can also be used to prevent pain.

Pulsed radiofrequency

Pulsed radiofrequency may be employed to stimulate the occipital nerves to keep them from sending pain signals. Although this procedure is more invasive than massage and medication, it does not damage any nerves or nearby tissue.


Surgery is reserved for the most painful and difficult cases. Through a process called microvascular decompression, doctors eliminate pressure on the nerves by moving encroaching blood vessels out of the way.

Home remedies

Home remedies can do a lot to relieve the pain when tight muscles, injury, and stress cause occipital neuralgia.

Rest, massage, and warm compresses can help individuals work out the kinks that are creating pressure in their necks.

Physical therapy can help individuals work through the crisis phase of their occipital neuralgia and provide them with exercises they can do to prevent a recurrence of this painful condition.

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