Occipital Neuralgia
Occipital neuralgia is nerve pain at the back of the head, neck and scalp. It usually feels like quick, sharp, shooting jolts, and it often shows up alongside migraine.
What is occipital neuralgia?
“Neuralgia” means nerve pain. “Occipital” refers to the back of the head. Occipital neuralgia happens when the occipital nerves, which carry feeling from the back of the head and scalp, become irritated or squeezed.
One headache specialist compares it to sciatica, but in the neck. The greater occipital nerve runs up toward the top of the head. The lesser occipital nerve curves toward the ear, which is why some people also feel discomfort in or around the ear.
It is a lot like trigeminal neuralgia, which causes shock-like pain in the face. Occipital neuralgia causes the same kind of pain, but at the back of the head.
Common symptoms
- Quick, sharp, stabbing or shooting pain at the back of the head, neck or scalp
- Pain set off by turning your head, such as looking over your shoulder, or by pressing on the area
- Pain triggered by lying in certain positions
- Pain on one side, often the dominant side, though both sides can be affected
- Discomfort near the ear
As the nerve pain gets worse, it can set off migraine-like attacks, with throbbing pain toward the front of the head, sensitivity to light and sound, nausea and vomiting. Migraine medicines may ease those migraine features but often do not help the nerve pain itself. This can lead to headaches nearly every day.
What causes it
Occipital neuralgia often starts when the nerves get squeezed as they pass through tight muscle and the tissue around it (fascia). Possible causes include:
- Whiplash and car accidents
- Sports injuries
- Years of poor posture, such as holding your head forward while texting, eating or driving
Occipital neuralgia and migraine
Pain in the back of the head and neck is common with migraine too, so the two can be hard to tell apart. Other headache types can also cause pain in this area, including cervicogenic headache, where neck muscles send pain up into the head.
The link between migraine and occipital neuralgia is complex. It is often unclear which one is driving the other. Treating migraine may ease neck pain, and the reverse can also be true. Sometimes the main cause only becomes clear after both are treated. If you have migraine, tell your doctor about any neck or back-of-head pain.
How it is diagnosed
Occipital neuralgia is often missed. A doctor may diagnose migraine based on light sensitivity and nausea without checking the neck. On the other hand, many people with pain at the back of the head assume it is occipital neuralgia when it is not. Headache specialists look for the shock-like, shooting quality of the pain. If the pain is not like that, another cause is more likely.
A clue is pain in the back of the head without typical migraine signs, such as nausea or light sensitivity. An occipital nerve block can also help with diagnosis: if numbing the nerve eases the pain, that suggests the nerve is involved.
In one group of patients seen for headache, including hard-to-treat headache, a headache specialist found that about 1 in 4 had some degree of occipital neuralgia. He notes this is higher than in much of the published research.
Treatment options
- Exercise and stretching: regular exercise, stretching and yoga are a good place to start, even before you see a doctor, along with healthy daily habits.
- Occipital nerve blocks: injections of numbing medicine at the back of the head. They are used both to diagnose and to treat. Some specialists use a larger amount of fluid to help free the nerve from tight surrounding tissue, and report that this often gives the most relief. Some people have lasting relief after one block. For others, relief lasts weeks or months, and blocks can be repeated.
- Neck injections may be another option when simpler steps have not helped.
- Preventive medicine taken daily, for pain that does not get better with other approaches.
- Neuromodulation devices, which stimulate or interrupt nerve signals. None is approved for occipital neuralgia, but some can treat migraine, so they may help people whose back-of-head pain is related to migraine.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience, and she has lived with migraine herself. She treats occipital neuralgia, along with cervicogenic headache and neck pain.
Every patient starts with a 90-minute new patient consultation with Dr. Park ($520): a full history review, a neurological exam, a diagnosis and a personalized treatment plan. The practice focuses on targeted injection treatments rather than a cycle of prescription medications. An occipital nerve block is $395, and trigger point injections for tight neck and shoulder muscles are $395. If appropriate, an injection may be done during your first visit for an added fee. See services and fees.
Appointments are Monday to Friday, 9 a.m. to 6 p.m., usually within days. The practice is direct pay with no referral needed.
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- Occipital Neuralgia: A Guide, American Migraine Foundation
- Neck Pain, Migraine, and Headache: How Are They Related?, National Headache Foundation
- Understanding Headache Locations, National Headache Foundation
Last updated October 27, 2026.
Sharp pain at the back of your head?
Every patient starts with a 90-minute new patient visit with Dr. Park.