Occipital Neuralgia
Sharp, shooting pain from the base of the skull over the scalp, caused by irritated occipital nerves.
Occipital neuralgia is pain caused by irritation of the occipital nerves, which run from the top of the neck up over the back of the scalp. It usually causes brief, sharp, shooting or electric pain, often on one side, with a tender scalp in between attacks. Dr. Patel confirms the diagnosis with an exam and, often, a diagnostic occipital nerve block, then treats the nerve and whatever is irritating it.
- Where it isNeck & head
- Treatment options05
- Who you seeAnup H. Patel, D.O.
- First visitExam and imaging review
Occipital Neuralgia
The occipital nerves are small nerves that leave the spine between the top bones of the neck. The greater and lesser occipital nerves travel through the muscles at the base of the skull and spread across the back and top of the scalp. When one of these nerves is pinched, stretched or inflamed, it can fire pain along its path. That pattern of pain is called occipital neuralgia.
The pain is distinctive. Many people describe sudden jolts, stabs or electric shocks that start at the base of the skull and shoot up the back of the head, sometimes reaching the side of the head, the forehead or the area behind the eye. Between jolts there may be an aching or burning soreness. The scalp can be so tender that brushing your hair or resting on a pillow hurts.
Occipital neuralgia is often confused with migraine, tension headache or cluster headache, and some people have more than one. The difference matters, because the treatments are not the same. The nerve can be irritated by tight neck muscles, an old neck injury such as whiplash, or arthritis in the upper neck joints. In some people, no cause can be found.
Dr. Patel examines the neck and scalp, presses gently along the course of the nerves and checks for other causes. A diagnostic occipital nerve block is often the clearest test. If numbing the nerve stops the pain, the nerve is very likely the source. Care usually begins with physical therapy, posture work and medication for nerve pain, with nerve blocks and other procedures added when those are not enough.
What it feels like · Why it happens
Mention these at your first visit. It saves time and helps focus the exam.
- Tight muscles at the base of the skull pressing on the nerve
- Neck injury, including whiplash from a car accident or a fall
- Arthritis or wear in the joints between the top two or three neck bones
- Disc disease in the upper neck
- Long periods of looking down, or a forward-head posture
- Conditions that affect nerves, such as diabetes
- Less often, gout, infection, inflamed blood vessels or a growth near the nerve
- In many people, no single cause is found
Where Dr. Patel looksHow Dr. Patel finds the source
Treatment only works when it is aimed at the right thing. This is how the source is confirmed.
- Step 01
A history of the pain, its pattern and what sets it off
- Step 02
Pressing along the occipital nerves to see whether this reproduces the pain
- Step 03
A neck exam for joint stiffness, muscle tightness and range of motion
- Step 04
A neurological exam of strength, sensation and reflexes
- Step 05
MRI of the neck or brain when other causes need to be ruled out
- Step 06
A diagnostic occipital nerve block; clear relief after numbing the nerve supports the diagnosis
- Step 07
Diagnostic blocks of the upper neck joints when the pain may start there instead
Your path to relief
Care moves one step at a time, from the least invasive option up, and only as far as you need.
First-line care
- Heat and gentle massage to the neck and base of the skull
- Physical therapy for neck posture, mobility and muscle tension
- Changes to your desk, screen and pillow to reduce neck strain
- Rest from activities that clearly provoke the pain
- Anti-inflammatory medication or a muscle relaxant for a short period, when appropriate
- Medications made for nerve pain, which Dr. Patel may prescribe after reviewing your health
- Relaxation and stress management, since stress tightens these muscles
Back to function
As a rehabilitation physician, Dr. Patel pairs every treatment with a plan to rebuild strength, movement and daily activity, so relief lasts.
Physical medicine & rehabilitation
Occipital Nerve Block
An injection at the back of the head that calms irritated occipital nerves to ease and diagnose headaches.
Radiofrequency Ablation
Heat applied to small pain-carrying nerves to quiet joint pain in the spine, knee or hip for months.
Medial Branch Blocks
A short-acting test that numbs the nerves to the spine’s facet joints to see if they cause your pain.
When to call
When to see a specialist
- You have shooting or electric pain at the back of the head
- Your scalp is tender to touch on one side
- Headaches started after a neck injury
- Headaches have not improved with over-the-counter medicine
- You have been told you have migraines, but your headaches don’t follow a typical migraine pattern
- Pain is disturbing your sleep or your ability to work
Go to the emergency room if
- A sudden, severe headache that peaks within a minute
- Headache with fever and a stiff neck
- Headache with weakness, numbness of the face or limbs, trouble speaking or loss of vision
- Headache after a significant head injury, especially with vomiting or confusion
Questions
How is occipital neuralgia different from a migraine?
What happens during an occipital nerve block?
How many nerve blocks will I need?
What if nerve blocks only help for a short time?
Is occipital neuralgia dangerous?
This page explains a condition or treatment in general. It is not a diagnosis or medical advice for you. Dr. Patel will explain what applies to you at your visit.
