Occipital Headaches
What it is
Occipital headaches are felt at the base of the skull and the back of the head, sometimes spreading toward the top or behind the eyes. Many of them start in the upper neck: the joints, muscles, and nerves there are closely linked to the back of the head, so irritation in the neck can be felt as a headache. When the small occipital nerves themselves are irritated, the condition is called occipital neuralgia.
What it feels like
The pain is often a steady ache or pressure at the back of the head, sometimes with sharp, shooting jolts, tenderness over the base of the skull, or discomfort when you move or hold your neck in one position. It is frequently one-sided and can be triggered by long hours at a desk or screen.
How we treat it
Most occipital headaches improve with non-surgical care:
- Physical therapy and posture work, especially for desk and screen habits
- Anti-inflammatory or other medication for limited periods
- An occipital nerve block, which can both confirm the source and quiet the pain
Surgery is rarely part of the picture unless a specific structural problem in the neck is driving the pain. My first job is to sort out whether the headache is coming from the neck, from the nerves, or from another type of headache altogether, because that decides the treatment.
The science — for the curious
The link between the neck and the back of the head comes from the way the upper cervical nerves share pathways with the nerves of the head — which is why a problem in the neck can be felt as a headache, and why treating the neck can relieve it. It also means occipital headaches can overlap with migraine and tension headache, so part of getting better is making sure we are treating the right thing.
Learn more
OrthoInfo — Neck Pain: orthoinfo.aaos.org
This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.