Occipital neuralgia is a type of headache and nerve pain that comes from irritation or injury of the occipital nerves, which run from the upper neck, through the back of the scalp, toward the top of the head and sometimes behind the eyes.
Patients often describe it as:
Sharp, shooting, or electric shock–like pain starting at the base of the skull
Pain that radiates up the back of the head and sometimes behind one eye
“Zapping,” stabbing, or burning sensations in the scalp
Scalp tenderness – even light touch, brushing hair, or resting on a pillow can trigger pain
Instead of a dull, band-like headache, occipital neuralgia feels like the nerves themselves are “angry.”
There are three main occipital nerves:
Greater occipital nerve – the largest; runs from the upper cervical spine (C2) and travels up the back of the head
Lesser occipital nerve – comes from the upper neck and runs more to the side of the scalp
Third occipital nerve – smaller branch that can contribute to localized pain at the skull base
When any of these nerves become compressed, inflamed, or sensitized, pain signals can fire continuously or in sudden bursts.
Common symptoms your patients will recognize:
Sudden stabbing or shock-like episodes of pain at the base of the skull
Pain that travels up one side of the head (sometimes both)
Throbbing or burning in the back of the head
Tender spots over the occipital nerves – pressing there can reproduce the pain
Light sensitivity or eye discomfort on the painful side
Pain worsened by:
Turning or extending the neck
Long periods of poor posture (computer, phone, driving)
Lying on a firm pillow or in certain sleep positions
Patients sometimes confuse occipital neuralgia with migraine or tension headaches, which is why a careful exam by a spine/pain specialist is so important.
Occipital neuralgia can be primary (no clear single cause) or secondary to another issue. Common contributing factors include:
Neck muscle tension or spasm – chronic tightness in the upper neck can irritate the nerve as it travels through muscle and fascia
Cervical spine arthritis or disc degeneration – especially around C2–C3 joints
Prior neck trauma – whiplash injuries, sports injuries, or falls
Posture strain – long hours at a computer, driving, or “tech neck” positions
Post-surgical changes – after neck fusion or other cervical procedures
Diabetes or nerve-sensitive conditions – which can make nerves more irritable in general
In many patients, it’s a combination of mechanical irritation (tight muscles, joint changes) plus nerve sensitivity.
There is no single “blood test” or scan for occipital neuralgia. Diagnosis is clinical, based on:
Detailed history of pain pattern:
Origin at the upper neck or skull base
Radiating along the scalp, often one-sided
Shock-like, stabbing, or burning quality
Physical exam:
Tenderness over the greater or lesser occipital nerves
Reproduction of pain when those nerves are pressed
Evaluation of neck motion, posture, and muscle tightness
Imaging (when appropriate):
Cervical spine X-ray, MRI, or CT to look for arthritis, disc disease, or instability
Diagnostic occipital nerve block:
Injecting numbing medicine around the occipital nerves
If pain improves significantly after the block, this strongly supports occipital neuralgia as a major source
That last one is key: an occipital nerve block is both a treatment and a diagnostic tool.
Treatment is usually stepwise, combining lifestyle, rehab, medications, and procedures.
Posture training and ergonomics
Physical therapy to address:
Upper cervical mobility
Deep neck flexor strength
Shoulder and scapular stabilizers
Heat, gentle stretching, and manual therapy
Stress management and sleep optimization
Depending on the patient, a physician may recommend:
Anti-inflammatory medications (NSAIDs)
Muscle relaxants for short-term use
Nerve stabilizing medications (e.g., certain anticonvulsants or antidepressants used for nerve pain)
These are often adjuncts, not long-term standalone solutions.
Here’s where your previous content plugs in perfectly:
An occipital nerve block places numbing medicine (and sometimes a small dose of steroid) around the irritated nerves at the skull base. This can:
Calm nerve inflammation
Interrupt pain signaling
Confirm that the occipital nerve is the main generator of symptoms
If patients get strong but temporary relief, this guides the next step.
For patients with chronic, severe occipital neuralgia who respond to blocks but relapse, specialists may consider:
Radiofrequency ablation (RFA) of the occipital nerves
Peripheral nerve stimulation (tiny leads placed near the nerve to deliver gentle electrical pulses)
More advanced cervical spine evaluation if underlying structural issues are suspected
These are individualized decisions made after careful evaluation by a spine or pain specialist.
Occipital neuralgia is typically painful and life-disrupting, but not usually life-threatening.
However, new, severe, or rapidly changing headaches should always be evaluated urgently to make sure nothing more serious is going on (like bleeding, infection, or vascular issues).
Red-flag symptoms include:
Sudden “worst headache of my life”
Fever, neck stiffness, confusion
Vision loss, double vision, or slurred speech
Weakness, numbness, or trouble walking
Those need emergency evaluation, not just a nerve block appointment.
Is occipital neuralgia the same as a migraine?
No. They can overlap, and some people have both, but occipital neuralgia is a nerve pain disorder from the occipital nerves, while migraines involve broader changes in brain and blood vessel activity. The pain in occipital neuralgia typically starts in the back of the head/neck and is more sharp or shock-like.
Can occipital neuralgia cause eye pain?
Yes. Pain from the occipital nerves can radiate behind the eye on the same side, which is why patients sometimes think it’s a migraine or eye problem at first.
Can occipital neuralgia go away on its own?
Mild cases may improve with rest, posture correction, and conservative care. Chronic or severe occipital neuralgia often needs targeted treatment, such as occipital nerve blocks, physical therapy, and sometimes more advanced procedures.
Is occipital neuralgia curable?
For some patients, addressing neck mechanics, posture, and nerve irritation can lead to long-term relief. For others, it behaves more like a chronic condition that can be managed with periodic treatments.
