Occipital Neuralgia

Getting an appointment with Cleveland Clinic’s occipital neuralgia experts is easy. We help you get the care you need.

Occipital neuralgia

Have you ever had a painful headache in the back of your head? It could be a rare headache disorder known as occipital neuralgia. This headache occurs when pain stems from the occipital region, or the back of your head, and spreads through the occipital nerves. The occipital nerves are at the top of your spinal cord and run up to your scalp. They control your head and neck.

Occipital neuralgia can be both a primary or secondary disorder, meaning it can either be its own condition or a symptom of an underlying disease.

There are several treatment options available to help you successfully manage the symptoms and pain from occipital neuralgia, especially if the underlying cause is treated.

While occipital neuralgia isn’t life-threatening, it’s painful.

What does occipital neuralgia feel like?

Pain from occipital neuralgia is felt in the back of the head in the occipital nerves.

Occipital neuralgia can feel like a sharp, shooting pain in the back of the head, usually on one side. It might be described as a throbbing or burning sensation. It can also cause sensitivity to light, scalp tenderness and pain behind the eye on the affected side. You may also feel pain at the base of your skull or behind your ear.

Unlike other headaches or migraines that slowly get more painful, occipital neuralgia can be triggered quickly, and by something as simple as brushing your hair. With occipital neuralgia, the severe pain is brief, lasting only a few seconds or a couple of minutes, and then goes away, whereas migraine pain is also severe, but lasts much longer.

Occipital neuralgia headaches are unlikely to have any symptoms such as drooping eye lids, eye redness or watery eyes. These symptoms are common with other primary headache disorders, such as migraines or hemicrania continua.

What causes occipital neuralgia?

Occipital neuralgia is commonly caused by pinched nerves in the root of your neck or because the muscles in your neck are too tight. In some cases, it can be caused by a head or neck injury.

However, since occipital neuralgia is also considered a secondary headache disorder, it can be a symptom of another condition. Conditions that may lead to or worsen occipital neuralgia include:

• Osteoarthritis, especially of the upper cervical spine, which can pinch nerves
• Tumors that grow on the nerve roots
• AVM (arteriovenous malformation)
• Brain aneurysm
• Brain tumor
• Meningitis
• Sleep disorders
• Stroke
• Sinusitis (inflammation of sinuses)
• Trigeminal neuralgia
• Rheumatoid arthritis
• Gout
• Infection

How is occipital neuralgia diagnosed?

Your provider will first do a comprehensive physical exam. They’ll ask about your medical history and how long you’ve been experiencing symptoms or if you have had any pain in the back of your head. One way your doctor may check to see if you experience pain is by applying pressure to the back of your head.

To check for an underlying cause, or rule out other conditions, your provider may order imaging tests such as an MRI or a CT scan. This will help them get a better look at your spine.

How do you get rid of occipital neuralgia pain?

In most cases, your doctor will recommend at-home treatments, such as applying a warm washcloth to the areas you feel pain and taking anti-inflammatory medications such as ibuprofen or naproxen. If you aren’t getting relief from those treatments, your doctor may prescribe muscle relaxers to relieve muscle tightness around the nerves.

If these more conservative methods don’t work, your doctor may inject a local anesthetic into your occipital area, or back of your head. This treatment can provide immediate relief and last for several hours.

For certain headache disorders like occipital neuralgia, an occipital nerve block can offer temporary relief. However, it’s important to note that the effectiveness of nerve blocks can be different from person to person. Discuss nerve blocks with your doctor to determine if this treatment option is suitable for you.

In rare cases, your doctor may recommend surgery to reduce pressure on the impacted nerves, especially if the pressure is caused by an underlying condition such as rheumatoid arthritis or osteoarthritis.

Occipital Neuralgia

What happens when a pain in the neck becomes a problem headache? Your scalp tingles. Something’s pounding behind your eye. Both are common signs of occipital neuralgia. Pinched nerves, tight muscles or injuries can aggravate nerves at the back of your scalp. And trigger these headaches. Often confused with other headaches, occipital neuralgia can be tricky to diagnose — but easy to treat. Cleveland Clinic’s skilled neurology team will find the source of your head and neck pain. And use what they learn to craft a care plan that treats your headache and the neck and spine problems causing it.

Why Choose Cleveland Clinic for Occipital Neuralgia Care?

Caring approach:

Chronic headaches and pain can disrupt life — and keep you from being your best self. Your quality of life is important. That’s why our caring providers are here for you. We listen to your concerns, answer your questions and guide you through treatment. Meet our team.

Skilled collaborative providers:

Occipital neuralgia is more than just a headache. So, you may see more than one provider. You’ll have a care team of experts from different specialties like neurology, pain management and physical therapy. They work together to deliver the most personalized care — and the best possible results.

Convenient care:

We make your treatments as convenient as possible. You can have some — like Botox ® (botulinum toxin) injections, trigger point injections and nerve blocks — at an office visit. And you may even find relief with over-the-counter anti-inflammatory medications. Our team will go over all treatment options with you

Innovation and research:

Cleveland Clinic constantly researches new ways to treat chronic nerve-related pain, like occipital neuralgia. We do this through clinical trials of medications, techniques and tools that aren’t widely available. Talk with your care team to see if you qualify for any of our current studies.

Virtual visits:

Your time is important. And not all appointments need to be in person. When you need a quick check-in with your care team, virtual visits save you time and travel.

National recognition:

Cleveland Clinic is a trusted healthcare leader. We’re recognized in the U.S. and throughout the world for our expertise and care.

Diagnosing Occipital Neuralgia at Cleveland Clinic

Occipital neuralgia is a secondary headache. This means another (underlying) health condition triggers the pain. This condition starts when the occipital nerves at the back of your head become inflamed or irritated. Things like tight muscles or disc problems can bother these nerves. This can cause burning or throbbing headaches on one side of your head or in the back of your eye. This pain can be similar to that of migraines and other headaches. So, it’s important to see headache experts who can make the correct diagnosis — and find the best treatment for you.

What to expect at your first visit

• What kind of pain are you having?
• Where is this pain?
• How often do you have pain?
• How long does the pain last?
• Have you had any injuries to your head, neck or back?
• Do you have other health conditions?

Next, your provider will do a physical exam and pay close attention to your head and neck. They’ll look for muscle tightness and check for painful spots and tingling areas. They’ll also order tests to rule out similar conditions like migraines.

Testing for occipital neuralgia

No single test pinpoints occipital neuralgia. So, you may have several different ones to help confirm a diagnosis.
Our team uses imaging tests like MRIs and CT scans to take a closer look at your spine, head and neck. We may also do an occipital nerve block to see if the pain stops once the nerve stops communicating. If it doesn’t, then we can check for signs of other conditions instead of occipital neuralgia.

Meet Our Occipital Neuralgia Team

Secondary headaches disorders like occipital neuralgia start from other health conditions. So, in treating your headaches, we’ll need to understand and treat what’s causing them. This means you’ll have a care team of providers from different specialties, like:

• Neurologists.
• Neurosurgeons.
• Orthopaedists.
• Pain management specialists.
• Physical therapists.
• Radiologists.
• Nurse practitioners.

These, and other skilled providers, team up to confirm your diagnosis and build your personalized care plan.

Providers Who Treat Occipital Neuralgia

Locations

Our healthcare providers see patients at convenient locations throughout Northeast Ohio and Florida.

Treating Occipital Neuralgia at Cleveland Clinic

Your treatment plan depends on your health and symptoms — and the conditions causing this pain. While we can do surgery to treat occipital neuralgia, our team will usually use less invasive therapies first.

Occipital neuralgia treatment without surgery

Your provider may recommend different things to treat your condition. You may do physical therapy or massages. And we may recommend using a heating pad at home.

We may also prescribe injections. Trigger point injections can target tight muscles causing your headaches and other symptoms. Botox injections can also relax stiffness. Occipital nerve blocks combine numbing medication and steroids to ease pain and inflammation. None of these are permanent. So, you’ll typically follow a regular injection schedule. Your care team will go over what to expect.

Medications can also help occipital neuralgia’s pain and inflammation. You may take nonsteroidal anti-inflammatory drugs (NSAIDs). Or your provider may recommend prescription medications to help with more severe symptoms and pain. What you’ll take depends on your unique diagnosis.

Surgery for occipital neuralgia

Your care team may recommend surgery if other treatments aren’t effective. We do several types, including occipital nerve and spinal cord stimulation. In both treatments, we implant small devices under your skin. They send mild electrical pulses to nerves and block pain signals. Your providers will decide if these pulses should be continual or occasional (intermittent).

We may also do occipital nerve decompression surgery. In this surgery, your provider frees your occipital nerves from the surrounding muscle, other tissue or blood vessels that may be compressing the nerves.

Taking the Next Step

Chronic pain can put you on life’s sidelines. But you don’t have to live with the headaches, pain and stiffness that come with occipital neuralgia. Cleveland Clinic’s expert healthcare providers are here to uncover the reasons behind your pain. And we walk you through what to expect from treatment and follow-up care — so you can get back to actively enjoying life.

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