What is this pain in the back of my head

Cervicogenic headaches may be accompanied by neck stiffness and arm or shoulder pain on the same side of the headache.

Pain in the Back of Your Head: What It Means

Smita Patel, MD is triple board-certified in neurology, sleep medicine, and integrative medicine.

Table of Contents
Table of Contents

When headache pain is on the back of your head, it’s often due to a primary headache disorder called a tension-type headache. This type of headache is very common and not a cause for alarm.

While it’s less common, secondary headaches (those that are caused by another health condition) are sometimes behind headache pain in the back of the head. Sometimes, this type of pain may be related to a serious issue.

This article reviews possible primary and secondary causes of headaches on the back of the head, how these headaches are treated, and when you should see a healthcare provider.

The problem isn’t a shortage of people wanting to be doctors, but rather, too few opportunities for training. Medical schools have increased class sizes by 30% since 2002, but federal funding for residency training – an essential step in the process of becoming a practicing physician – has not increased since 1997, according to Inside Higher Ed.

Pain All Over the Back of the Head

Headache pain all over the back of the head is most commonly a tension-type headache. While nagging and unpleasant, tension-type headaches are not worrisome, and most can be relieved fairly quickly.

Less often, headache pain on the back of your head can indicate a more serious secondary headache, such as a low-pressure headache.

Tension-Type Headache

Tension-type headaches are the most common type of headache and, therefore, the most likely source of a “back of the head” headache.

These headaches cause a gripping, tightening, or pressure-like sensation around the head and neck. Imagine wearing a tight headband or a baseball hat that is too small. The headache pain is mild-to-moderate in intensity and doesn’t worsen with physical activity.

Experts aren’t completely sure why tension-type headaches develop. It’s likely that multiple factors are involved, such as sensitization of pain pathways in the nervous system and/or environmental triggers like stress, lack of sleep, or skipping meals.

Symptoms that may accompany a tension-type headache include:

• Light or sound sensitivity (not both)
• Reduced appetite
• Shoulder and upper back stiffness
• Trouble concentrating

Low-Pressure Headache

A low-pressure headache, also known as spontaneous intracranial hypotension, develops as a result of low cerebrospinal fluid pressure in the brain. Cerebrospinal fluid (CSF) is a clear fluid that flows through and cushions the brain and spinal cord.

If spinal fluid leaks because of a tear in the dura (one of the membranes that cover the spinal cord), pressure around the brain is lowered. This causes a severe headache, typically felt at the back of the head.

How Does a Dural Tear Occur?

A tear in the dura may occur after a spinal tap (a medical procedure to sample CSF) or following spinal or epidural anesthesia.

A low-pressure headache is felt when sitting or standing up and is relieved within 20 to 30 minutes of lying flat. It’s usually also worsened when coughing, sneezing, or exercising.

Symptoms that may accompany a low-pressure headache include:

• Neck stiffness
• Tinnitus (ringing in the ears)
• Dizziness
• Double vision or blurry vision

Back Right or Left Side of the Head

Sometimes headaches are felt at the back of the head, but only on one side. Cervicogenic headache and occipital neuralgia are secondary headaches that present in such a manner.

Cervicogenic Headache

Cervicogenic headaches are believed to be caused by a bone, joint, nerve, or a soft tissue problem in the upper spine, such as arthritis, a pinched nerve, or neck muscle spasm or injury.

Cervicogenic headaches manifest as one-sided headaches that begin in the neck and spread from the back of the head to the front. The pain is usually moderate-to-severe in intensity, non-throbbing, and worsens with certain head or neck movements.

Cervicogenic headaches may be accompanied by neck stiffness and arm or shoulder pain on the same side of the headache.

Occipital Neuralgia

Occipital neuralgia is pain in the areas of skin supplied by the greater occipital or lesser occipital nerves. These nerves originate in the neck and travel up to each side of the head to the scalp.

The pain of occipital neuralgia is believed to arise from occipital nerve entrapment or irritation by a tight muscle, blood vessel, or trauma during a whiplash injury.

The headache associated with occipital neuralgia is typically one-sided, severe, sudden in onset, and stabbing or shooting in nature. It classically begins in the neck and spreads from the back to the top of the head.

Symptoms associated with occipital neuralgia include:

• Vision changes and/or eye pain
• Tinnitus
• Stuffy nose
• Decreased or abnormal sensations along the nerve

Please note this chart does not list all possible causes of headache pain in the back.

Treatment

Once your headache type is diagnosed, you can move forward with a treatment plan.

Tension-Type Headache

Tension-type headaches are usually alleviated with an over-the-counter pain reliever like Tylenol (acetaminophen) or the nonsteroidal anti-inflammatory drug (NSAID) Advil (ibuprofen).

Be sure to talk to your doctor before taking any medication. In addition to ensuring it’s safe, you want to avoid complications like medication overuse headaches. These headaches occur when your body becomes accustomed to painkillers.

Low-Pressure Headache

Conservative therapies like bed rest, caffeine, and hydration are usually implemented first to manage a low-pressure headache. Headaches tend to resolve within a few days to two weeks.

If the headache is severe or persists, a procedure to place an epidural blood patch may be performed. During this procedure, your own blood is removed from your arm and injected into the epidural space (located just outside the dura) in the lower spine. Relief is usually immediate.

Cervicogenic Headache

Physical therapy tends to be part of the initial treatment plan for cervicogenic headache. A physical therapist can combine cervical neck manipulation and mobilization along with neck muscle strengthening exercises.

Maintaining good posture, massage, and ice/heat therapy are also usually recommended. In some cases, patients may be prescribed a nerve pain medication called Lyrica ( pregabalin ).

For severe or persistent headaches, a pain specialist may perform an anesthetic (numbing) blockade or a corticosteroid injection into the neck.

Occipital Neuralgia

There are multiple treatment options for occipital neuralgia, depending on the severity of the condition.

Common treatments include:

• Medications like Neurontin ( gabapentin ), Lyrica, or a tricyclic antidepressant
• Physical therapy that incorporates ice/heat therapy, massage, and neck strengthening and stretching exercises
• Nerve block of the greater or lesser occipital nerve

For more severe or persistent cases, botox injections or a minimally invasive procedure that delivers bursts of radiofrequency to the occipital nerve (called pulsed radiofrequency) may be tried.

Surgical release of the occipital nerve tends to be a last resort option.

When to See a Healthcare Provider

Most headaches are not dangerous. There are instances, however, in which your headache warrants a visit or call to your healthcare provider.

These scenarios include:

• Your headaches are becoming more frequent, severe, or interfering with your daily routine.
• You have a new headache and are over age 50, are pregnant or just gave birth, or have a history of cancer or a weakened immune system (e.g., HIV/AIDS).
• Your headache is triggered by sneezing, coughing, or exercising.
• You are experiencing a headache associated with taking pain medication regularly.

Seek Emergency Care

Go to your emergency room or call 911 if your headache:

• Is severe, begins abruptly, and/or is the “worst headache of your life”
• Is severe and accompanied by a painful red eye, high fever, stiff neck, or confusion
• Is associated with symptoms of a possible stroke (e.g., weakness, numbness, or vision changes)
• Occurs after a blow or injury to your head

Summary

Headaches felt at the back of the head are usually tension-type headaches. A “back of the head” headache may also stem from an underlying health condition like arthritis or an irritated nerve in your neck or scalp.

Once your headache type is diagnosed, treatment is usually fairly simple. It may involve medications, physical therapy, or certain procedures.

Frequently Asked Questions

How long does a headache last?

Different types of headaches can last for varying amounts of time, depending on their severity and whether or not they are treated. For instance, tension-type headaches can last anywhere from 30 minutes to seven days.

What can you take for a headache when you’re pregnant?

If possible, it’s best to resort to non-medication options for treating a headache during pregnancy. You might try taking a nap in a dark, quiet room or applying a cool compress to your head. Reach out to your healthcare provider if your headache is new, persistent, worsening, or severe. In some instances, your doctor may give you the OK to take Tylenol (acetaminophen).

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Jensen RH. Tension-type headache – the normal and most prevalent headache. Headache 2018;58(2):339-345. doi:10.1111/head.13067
2. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Tension headache.
3. American Migraine Foundation. What to know about low pressure headaches.
4. Amorim JA, Gomes de Barros MV, Valenca MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012;32(12):916-923. doi:10.1177/0333102412453951
5. Verma S, Tripathi M, Chandra PS. Cervicogenic headache: current perspectives. Neurol India. 2021;69(Supplement):S194-S198. doi:10.4103/0028-3886.315992
6. Narouze S. Occipital neuralgia diagnosis and treatment: the role of ultrasound. Headache. 2016;56(4):801-807. doi:10.1111/head.12790
7. Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. J Korean Med Sci. 2016;31(4):479-488. doi:10.3346/jkms.2016.31.4.479
8. Kwak KH. Postdural puncture headache. Korean J Anesthesiol. 2017;70(2):136-143. doi:10.4097/kjae.2017.70.2.136
9. Raciciki S, Gerwin S, DiClaudio S, Reinmann S, Donaldson M. Conservative physical therapy management for the treatment of cerviocogenic headache: a systematic review. J Man Manip Ther. 2013;21(2): 113–124. doi:10.1179/2042618612Y.0000000025
10. Boudreau GP, Marchand L. Pregabalin for the management of cervicogenic headache: a double blind study. Can J Neurol Sci. 2014;41(5):603-610. doi:10.1017/cjn.2014.2
11. Phu Do T, Remmers A, Schytz HW et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134-144. doi:10.1212/WNL.0000000000006697

By Colleen Doherty, MD
Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.

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Some headache symptoms occur specifically in the back of the head. Possible causes include tension, migraine, and medication overuse.

This article looks at five of the most common causes of pain in the back of the head:

• tension-type headaches
• migraine
• medication overuse headaches
• occipital neuralgia
• exercise-induced headaches

We also take a look at their symptoms, possible treatments, and prevention methods.

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Tension or tension-type headaches (TTH) usually cause forehead pain, but they are also the most common cause of pain in the back of the head. They can last for up to 7 days, but they can also be brief, lasting for as little as 30 minutes.

The symptoms of a tension-type headache are:

• a feeling of tightening around the back or front of the head
• pain that is mild to moderate but occasionally severe
• the headache is not made worse by exercise
• no nausea or vomiting

Treatment

Taking pain relief such as aspirin or acetaminophen is usually enough if tension headaches are infrequent.

When they occur more often, lifestyle modification and/or alternative treatments may help reduce their frequency and length.

Treatment options include:

• relaxation techniques
• cognitive behavioral therapy
• massage
• physical therapy
• acupuncture

Causes and prevention

The cause of TTH is not currently known, but several factors are potential triggers. These include:

• stress
• fatigue
• lack of sleep
• missing meals
• poor posture
• arthritis
• sinus pain
• not drinking enough water

Migraine headaches are a common type of recurring headache that often start during childhood and increase in frequency and severity with age.

In adulthood, they can occur several times a week, especially in females between the ages of 35 and 45 years.

Common symptoms of migraine include:

• throbbing intense pain on one side of the head
• nausea and vomiting
• visual disturbance
• heightened sensitivity to light, noise, and smell
• muscles tenderness and sensitive skin
• last from a few hours to several days
• physical activity makes them worse

An “aura” might precede a migraine headache, in which the person experiences flashing lights or other visual disturbances.

Triggers

A variety of factors specific to each person might trigger migraine episodes.

These factors may be emotional, physical, environmental, dietary, or medication-related, and include:

• stress
• menstrual or other hormone changes
• anxiety or depression
• flashing and bright lights, loud noises, or strong smells
• lack of food
• inadequate sleep
• certain food types, such as cheese, chocolate, and caffeine
• taking a contraceptive pill

Causes and treatment

Inflammatory substances that trigger pain sensors in the blood vessels and nerves of the head might cause migraine.

To treat migraine a person should take analgesics, such as aspirin or acetaminophen, and rest in a darkened room.

If normal analgesics do not work, then a doctor might prescribe antimigraine drugs known as triptans. These drugs cause blood vessels to shrink and contract, which reverses some of the changes in the brain that cause migraine.

The sooner a person receives treatment for a migraine epsiode, the more effective that treatment will be.

Prevention

People can take certain steps to reduce the risk of migraine. These steps include:

• medications specifically approved for migraine prevention
• prevention with medication that is usually used for epilepsy, depression, or high blood pressure
• stress management, exercise, relaxation, and physical therapy
• noting down and avoiding personal triggers, including avoiding certain foods
• hormone therapy

Medication-overuse headaches (MOH) may develop if a person uses too much pain relief medication. MOH headaches are also known as rebound headaches.

Occasional use of pain relief does not cause any problems. However, when a person takes pain relief medication more than two or more days a week over an extended period, a medication overuse or rebound headache can occur.

• persistent, almost daily headaches
• worse pain when waking
• a headache after stopping pain relief

Other problems associated with MOH are:

• sleepiness
• nausea
• anxiety
• irritability
• lack of energy
• physical weakness
• restlessness
• difficulty concentrating
• depression

Treatment

The best treatment for a medication overuse headache is often to taper or stop taking pain relief medication entirely. Headaches will become worse at first but will quickly resolve. A person can then resume taking their normal or preferred pain relief medication.

In more severe cases , people should see a doctor. An individual may need physical or behavioral therapy to break the cycle of using pain relief.

For certain medications, such as opioids, a doctor will need to recommend a gradual reduction in dosage, as instantly stopping some medications could be dangerous.

Prevention

To prevent a medication overuse headache, people should avoid using pain relief medication for headaches more than a couple of times per week. If headaches requiring pain medication are persistent and frequent, seek advice from a doctor for better prevention and treatment.

Occipital neuralgia is a distinctive and less common type of headache that tends to begin at the base of the neck and spreads up to the back of the head, then behind the ears.

It may relate to damage or irritation of the occipital nerves, which run up the back of the neck to the base of the scalp.

Underlying diseases, neck tension, or other unknown factors might cause the damage or irritation.

The pain in occipital neuralgia can be severe. Other symptoms include:

• continuous throbbing and burning ache
• intermittent shocking or shooting pains
• pain is often on one side of the head and can be triggered by moving the neck
• tenderness in the scalp
• sensitivity to light

Diagnosis

Due to the similarity of symptoms, a person or medical professional might mistake occipital neuralgia for a migraine headache or another type of headache. A distinguishing feature of occipital neuralgia is pain after applying pressure to the back of the neck and scalp.

Sometimes, a doctor may diagnose occipital neuralgia by injecting a local anesthetic close to the occipital nerves, providing a temporary nerve block. If the pain decreases, then a doctor will likely diagnose occipital neuralgia.

As occipital neuralgia can be a symptom of other disorders, the doctor may also check for other underlying conditions.

Causes

• damage to the spine or discs
• osteoarthritis
• tumors
• gout
• nerve damage caused by diabetes
• inflammation of blood vessels
• infection

Treatment

Applying heat packs, resting, massage, physical therapy, and taking anti-inflammatory medications, such as aspirin or naproxen, can help reduce pain levels. Various types of heat packs are available online.

If pain is severe, a person with occipital neuralgia may need to take oral muscle relaxants or nerve-blocking medications. For severe pain, a medical professional may recommend a local anesthetic or steroid injections.

On rare occasions, a person may need surgery to reduce pressure on the nerves or block pain messages to this part of the body.

Exercise-induced headaches occur as the result of strenuous physical activity. They start suddenly during or immediately after exercise, rapidly becoming severe.

A wide range of exercises might trigger this pain, from weightlifting or running to sexual intercourse and straining on the toilet.

Symptoms include a pulsating pain on both sides of the head, which can last from 5 minutes to 2 days. These headaches are usually isolated events and may also produce migraine-like symptoms.

Causes and prevention

The cause of these headaches is unknown. They typically only occur for 3–6 months. Methods for preventing them from recuring include:

• taking pain relief medication before exercise
• avoiding strenuous activity
• warming up properly
• drinking enough fluids
• eating nutritious foods
• getting enough sleep

Treatment consists of using normal headache pain relief medication, such as aspirin or acetaminophen.