Occipital Neuralgia: What Is It?

Medically Reviewed by Poonam Sachdev on June 03, 2024
Written by Hedy Marks, Rachel Reiff Ellis
6 min read

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.

infographic on occipital neuralgia

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
  • Numbness
  • Pain behind your ears

Occipital neuralgia first symptoms

Occipital neuralgia pain often starts at the back of your head at your neck and spreads upward to one or both sides of your head. Or you may first feel it behind one eye.  

For some people, all it takes to trigger these symptoms is certain movements, like combing your hair, turning your head, or simply lying on a pillow.

Occipital neuralgia vs. migraine

Occipital neuralgia and migraine are very similar and can often be confused for each other. They both can cause pain from the base of your head up to and on your scalp, behind your eyes, and pain when moving your neck. You can even have sharp, piercing pain in your upper neck and back of the head with both. 

But migraine usually comes with light sensitivity and nausea. Those two symptoms aren’t part of occipital neuralgia pain.

The two conditions also have different causes. Occipital neuralgia pain comes from compressed or irritated nerves, while migraine happens because of changes in the brain. Sometimes it’s hard to know which you have until you’ve tried treatment for it to see which works. 

How long does occipital neuralgia last?

Sometimes occipital neuralgia can be lighting fast, with sharp pain lasting just seconds or minutes. But it can also last much longer and last as long as a migraine. It can also become chronic, and come back from time to time even after successful treatment. 

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
  • Osteoarthritis
  • Tumors in the neck
  • Cervical disc disease
  • Infection
  • Gout
  • Diabetes
  • Blood vessel inflammation

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 a CT or MRI scan to look at your spine if your doctor thinks your case isn’t typical. 

If your doctor suspects you have occipital neuralgia, they may use a handheld ultrasound device to look for trigger points. Ultrasound can help them see which areas may be irritating  your occipital nerve and causing pain. 

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.

Medication for occipital neuralgia

If those don’t help, your doctor may prescribe medications for you, including:

  • Prescription muscle relaxants
  • Anti-seizure drugs such as carbamazepine (Tegretol) and gabapentin (Neurontin)
  • Antidepressants
  • 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.
  • Botox injections to reduce inflammation

Occipital neuralgia surgery

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.
  • Spinal cord stimulation. In this surgery, your doctor puts electrodes between your spinal cord and vertebrae (spinal bones). The electrodes emit electrical impulses to block pain messages. 
  • Occipital release surgery. During this surgery, a doctor makes an incision in the back of your neck to release the occipital nerve from muscles or connective tissue that’s squeezing them.
  • Ganglionectomy. This surgery involves removing certain nerve cells at the top of your spine.

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.

Occipital neuralgia is a headache disorder that affects nerves that run through your scalp (the occipital nerves). It causes pain in the back of your head or behind the eyes. Many of the symptoms are similar to migraine, so it’s important to get the right diagnosis from a doctor. Treatment with medication, or in rare cases surgery, usually relieves the pain.

What triggers occipital neuralgia?

You might get occipital neuralgia after an injury or because of a pinched nerve. Tightness in your neck muscles or a disease that affects your discs (the spongy cushions that separate the vertebrae, or bones, of your spine) may cause it. If you have an infection or inflammation, you may also get it. When you have occipital neuralgia, pain can be triggered by certain movements, such as combing your hair, or pressing on your scalp.

Will occipital neuralgia go away?

For most people, treatment will help heal your nerve and get rid of the pain. It’s possible for the pain to come back, however, such as if a steroid shot wears off. You may have to do stretches or continue with medications to keep it from returning.

Are there ways to cure occipital neuralgia naturally?

There are non-medical tools you can use to help treat occipital neuralgia. A heating pad on your scalp can help ease pain where you feel it most. Physical therapy or massage therapy can help your muscles relax.

Can sleeping wrong cause occipital neuralgia?

Certain sleeping positions can cause tight muscles in the neck, which may cause occipital neuralgia.