What is Occipital Neuralgia?

There are two nerves that travel through the back of the head and are called the occipital nerves. Impairment, inflammation or stress on either or both of these nerves and many other conditions may lead to occipital neuralgia. This causes headache especially in the back of the head and other symptoms that may be very difficult to endure.

The pain felt with this condition is often described as burning or shooting, and it may start in the neck, heading up the back of the skull and usually branching off to one side of the head in the direction of the eye. The occipital nerves don’t affect the front of the head, so headache that is in the forehead or the face is unlikely to be occipital neuralgia. However, the condition has been compared to migraines in other respects.

Though most often pain affects one side of the head, it may affect both if both occipital nerves become irritated or are involved. Other types of pain or sensitivity can be associated with this condition too. This includes sensitivity of the skin and surface of the head so that touching it for things like grooming or shampooing become extremely difficult due to discomfort.


There are many potential causes of this condition, including tightness or tension in the neck cause by things like repeatedly keeping the head down (perhaps by typing at a laptop). Traumatic injury to the neck or head might damage one of the occipital nerves or some forms of arthritis in the cervical spine may cause pressure on the nerve. Tumors in the cervical spine could have a similar result. Sometimes people with diabetes get this condition and another cause could be certain forms of infection. In many cases, there is no explanation for inflammation of the occipital nerves.

Diagnosing occipital neuralgia can be done in a number of ways. Doctors, typically neurologists, might perform magnetic resonance imaging (MRI) or computerized axial tomography scans (CAT scans), to see if there is any potential injury or blockages present in the cervical or neck spine. Another way this condition is often diagnosed is by performing a nerve block on the occipital nerve suspected of creating the problem. This causes the nerve to go completely numb, temporarily, and if occipital neuralgia is the cause of a patient’s pain, the nerve block typically relieves pain and confirms diagnosis.

Once a patient has been diagnosed, there remains the issue of how to treat the condition in a more permanent way. There are several potential treatments and if doctors determine a direct cause, they may have a better idea as to how to proceed. Many begin with conservative non-surgical treatment methods, which might involve administering medications to reduce pain. Common choices are non-steroidal anti-inflammatory drugs (NSAIDs) and medications like Tegretol®, Neurontin®, or sometimes some antidepressants. Using heat and massage of the neck may also prove helpful.

When pain is long lasting and resists treatment with medications, doctors might suggest some methods of relieving pain that will destroy or impair the occipital nerve to reduce pain. This does have the unpleasant side effect of leaving part of the head numb to feeling, but for many feeling nothing is far better than being subject to constant pain. These procedures, including cutting or burning the nerve, will usually be employed only if a patient has responded well to an occipital block. Many people do not need to have surgery to fix occipital neuralgia and could respond well to more conservative treatment.


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Discuss this Article

Post 7

Hello I had rt greater occipital nerve cut 30 years ago and the surgeon's 'one mm' of numbness can be and usually is half my head.

Post 6

Frozen shoulder or shoulder impingement is something affects a lot of people. It not only has the ability to destroy posture, but affects doing everyday, mundane tasks as well. The good news is you aren't alone and there are proven ways to fix it.

Post 5

I've suffered with migraines for 20 years. I've heard acupuncture helps. I've always felt I had arthritis of the neck. I may look into some of these posts. I'd like to get off sumatriptan. I've taken for 20 years. It's the only thing that helps. But I can't pin my hair up at all. I'll get a headache. After migraines my skull is tender to touch for a day or two. I need a cure!

Post 4

@anon 132621: Did prolotherapy work for you?

Post 3

i have been treated for occipital nerve pain

with steroids, injections, a chiropractor, osteopath, topical gels. the only long lasting relief has been from acupuncture for up to six months.

Post 2

From my own experience, if you experience both pain in the back of the neck and behind your eyes there is a good chance you have occipital neuralgia (splenius capitis, cervicis muscles). These muscles will be tight and need to be released and this seems to be the good enough (osteopathy works wonders).

However, if it still there after several weeks it may be that the ligaments have become lax because of constant neck forward bending. This is a vicious circle: the ligaments can't hold the vertebra as they are lax, so the muscles try and do the holding work by becoming tight, tightness equals tension and hence occipital neuralgia. Solution: fix the source of the problem = fix the ligaments.

How? Prolotherapy. I still haven't gone for it, I will in some months. no surgery required, just injections.

Post 1

At last, I know what is wrong with me. I have had this for over two years, and was treated for migraines and tension headaches but little relief. I have the shooting pains behind my eye and my neck and back of head is tender and sore right now at this moment. I also have a shoulder impingement and about to have surgery this month. Hoping this will help with headache in some way. Wonderful information, so glad to know at last what I have.

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