Occipital Neuralgia

Occipital neuralgia happens when there’s pressure or irritation to your occipital nerves, maybe because of an injury, tight muscles that entrap the nerves, or inflammation. Many times, doctors can’t find a cause for it.

4 reasons why you have pain at the base of your skull, including overusing common painkillers

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Ilan Danan, MD, MSc, sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, CA

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• Having pain at the base of your skull could indicate a tension headache or neck injury.
• If you’re experiencing a shooting pain or pain behind the eyes, it may be occipital neuralgia.
• If you have symptoms like changes in vision, numbness, and nausea, see a doctor immediately.

Most of us will experience a headache at some point in our lives, but not all headaches are the same. How intense the pain is, how long it lasts, and its location on your head can indicate whether you are experiencing a typical headache or something more serious.

Pain at the base of the skull, for example, can be a sign of an underlying medical condition that may require treatment, says Dr. Joey Gee, medical director of the concussion clinic at Providence Mission Hospital.

Here are four reasons why you might experience pain at the base of your skull and potential treatment options for each cause.

1. Tension headache

This is the most common type of headache, estimated to affect about two in three adults in the US at some point.

A tension headache is typically described as a tight feeling across the forehead, but the pain can also extend to the sides and back of the head and down to the neck, Gee says.

Common causes of tension headaches are stress and lack of sleep. But you may also experience a tension headache if you strain a group of muscles at the base of the skull called suboccipital muscles.

These muscles can become tense due to poor posture, eye strain, or another injury, like whiplash. Whiplash, in particular, can be responsible for a tension headache that starts at the base of your skull and extends to the rest of your head.

Treatment for tension headaches depends on the underlying cause but can include:

• Lifestyle changes, like exercising regularly, stress management techniques, and improving sleep hygiene so you get adequate rest.
• Over-the-counter pain relievers, like Ibuprofen or acetaminophen can offer temporary relief but if the headaches are recurring, it’s important to address the underlying cause.
• Prescription medications, including tricyclic antidepressants or muscle relaxers.
• Icing or heating your neck and gentle range of motion exercises can help ease pain caused by whiplash.
• Physical therapy may help improve symptoms through massage and mobility exercises.

2. Occipital neuralgia

Occipital neuralgia is a condition caused by inflammation or injury to the nerves running from the top of the spine to the head, says Dr. Sean Ormond, a pain management doctor with Atlas Pain Specialists. This inflammation can result in throbbing, shock-like pain at the back of the head or the base of the skull.

Causes of occipital neuralgia include:

• Trauma to the back of the head
• An infection of the nerves
• Pinched nerves or muscle tightness in the neck
• Arthritis in the upper cervical spine
• Gout
• Diabetes

In addition to throbbing pain at the base of the skull, other symptoms of occipital neuralgia include:

• Pain behind the eyes
• Shooting pains that start at the base of the head and go to the scalp
• An aching or burning sensation at the base of the skull

Treatment will depend on the severity of your condition and your medical history, but may include:

• Physical therapy
• Massage therapy
• Medications, such as muscle relaxers or anti-inflammatories
• Surgical treatments, such as occipital nerve stimulation or spinal cord stimulation, which can help reduce pain by producing electrical impulses to block pain messages between the spinal cord and brain.

3. Herniated cervical discs

Spinal discs are cushioned shock absorbers that sit between the bones, or vertebrae, of your spine.

The discs located in your neck are called cervical discs.

An injury or repetitive strain on your neck can damage those cervical discs, causing them to herniate, or push the inner part of the disc out. This can irritate the tissue and nerves in the area.

You may be at an increased risk of a herniated disc if you have a family history of herniated discs or you are over the age of 40. This is because disc material naturally degenerates as we age and the ligaments that hold the discs in place also begin to weaken. As a result, a mild strain on the neck or an abrupt twisting motion that wouldn’t cause damage in a younger individual can lead to a herniated disc in an older adult.

If the herniated disc is not pushing on a nerve, you may not experience much pain at all, and the disc will heal on its own. However, if the herniated disc is pinching a nerve, you may experience pain, numbness, and tingling in parts of the body affected by the pinched nerve.

If the disc is in your neck, you may feel pain in there and at the base of the skull.

• Pain in your shoulder, arm, or hand
• Weakness in the affected area
• A sharp or shooting pain down your shoulder or arm when you cough or sneeze
• Numbness or tingling in your arms
• Neck stiffness

Treatment for a herniated cervical disc may include:

• Over-the-counter pain medications, such as ibuprofen or acetaminophen.
• Prescription medications, such as muscle relaxers
• Physical therapy
• In severe cases, surgery to remove the protruding disc

4. Medication overuse

People who take pain relievers two or more days a week for headaches may experience “rebound headaches” that can cause pain at the base of the skull, Gee says.

Doctors don’t yet know exactly why frequently using pain relievers can actually trigger headaches in some people, but any acute pain-relieving medication has the potential to lead to medication overuse headaches.

Some of these include:

• Acetaminophen
• Over-the-counter combination pain relievers, such as Excedrin
• Certain migraine medications, like Zomig or Ergomar

In most cases, medication overuse headaches stop when you stop taking the medication that is triggering them.

However, if you deal with frequent headaches, simply not taking pain medication may not be an option. Talk with your doctor about the frequency of your headaches, any pain relievers you are currently using to treat your headaches, and the severity of your symptoms. Your doctor may suggest stopping one of these medications or slowly tapering off.

When to see a doctor

If you experience headaches four or more days a month or your symptoms are interfering with your daily life, talk with your doctor about treatment options. These may include preventive medication or lifestyle changes that can help reduce the frequency of your headaches

Also, seek medical attention if you experience pain at the base of your skull accompanied by:

• Shooting pain down one or both of your arms
• Numbness or tingling in your arms
• Pain behind the eyes
• Shooting pains that start at the base of the head and go to the scalp
• Changes in vision
• Nausea or vomiting

Insider’s takeaway

Pain at the base of the skull can be a symptom of the most common type of headache known as a tension headache. Tension headaches are not usually a cause for concern and can be treated with over-the-counter pain relievers.

But pain at the base of the skull may also signal a serious medical issue like occipital neuralgia or a herniated disc.

Treatment options for occipital neuralgia or a herniated cervical disc may include physical therapy, medication, or surgery.

Erin Heger

Erin Heger is a freelance journalist located in the Kansas City area. She primarily covers stories related to healthcare policy, maternal mental health, parenting, and personal finance. Her work been featured in The Atlantic, Rewire.News, Refinery29, HuffPost, and more.

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Occipital Neuralgia

Occipital neuralgia is a condition in which the nerves that run from the top of the spinal cord up through the scalp, called the occipital nerves, are inflamed or injured. You might feel pain in the back of your head or the base of your skull.

People can confuse it with a migraine or other types of headache, because the symptoms can be similar. But treatments for those conditions are very different, so it’s important to see your doctor to get the right diagnosis.

Symptoms

Occipital neuralgia can cause intense pain that feels like a sharp, jabbing, electric shock in the back of the head and neck. Other symptoms include:

• Aching, burning, and throbbing pain that typically starts at the base of the head and goes to the scalp
• Pain on one or both sides of the head
• Pain behind the eye
• Sensitivity to light
• Tender scalp
• Pain when you move your neck

Causes

Occipital neuralgia happens when there’s pressure or irritation to your occipital nerves, maybe because of an injury, tight muscles that entrap the nerves, or inflammation. Many times, doctors can’t find a cause for it.

Some medical conditions are linked to it, including:

• Trauma to the back of the head
• Neck tension or tight neck muscles
• Osteoarthritis
• Tumors in the neck
• Cervical disc disease
• Infection
• Gout
• Diabetes
• Blood vessel inflammation

How It’s Diagnosed

Your doctor will ask you questions about your medical history and about any injuries you’ve had. They’ll do a physical exam, too. They’ll press firmly around the back of your head to see if they can reproduce your pain.

They may also give you a shot to numb the nerve, called a nerve block, to see if it gives you relief. If it works, occipital neuralgia is likely the cause of the pain. You might also have blood tests or an MRI scan if your doctor thinks your case isn’t typical.

You have to get the right diagnosis to get the right treatment. For example, if you have occipital neuralgia and you get a prescription for migraine medication, you may not get relief.

Treatments

The first thing you’ll want to do is to relieve your pain. You can try to:

• Apply heat to your neck.
• Rest in a quiet room.
• Massage tight and painful neck muscles.
• Take over-the-counter anti-inflammatory drugs, like naproxen or ibuprofen.

If those don’t help, your doctor may prescribe medications for you, including:

• Prescription muscle relaxants
• Antiseizure drugs, such as carbamazepine (Tegretol) and gabapentin (Neurontin)
• Antidepressants
• Nerve blocks and steroid shots. The nerve block that your doctor might do to diagnose your condition can be a short-term treatment, too. It may take two to three shots over several weeks to get control of your pain. It’s not uncommon for the problem to return at some point and to need another series of injections.

An operation is rare, but it might be an option if your pain doesn’t get better with other treatments or comes back. Surgery may include:

• Microvascular decompression. Your doctor may be able to relieve pain by finding and adjusting blood vessels that may be compressing your nerve.
• Occipital nerve stimulation. Your doctor uses a device called a neurostimulator to deliver electrical pulses to your occipital nerves. They can help block pain messages to the brain.

Occipital neuralgia is not a life-threatening condition. Most people get good pain relief by resting and taking medication. But if you still hurt, tell your doctor. They’ll want to see if there’s another problem that’s causing your pain.

Show Sources

SOURCES:
National Institute of Neurological Disorders and Stroke: “NINDS Occipital Neuralgia Information Page.”
American Association of Neurological Surgeons: “Occipital Neuralgia.”
Jan Brandes, MD, director, Nashville Neuroscience Group at St. Thomas Health Services; assistant clinical professor, Vanderbilt University, Nashville, Tenn.