Occipital neuralgia is a type of chronic headache disorder that results from irritation or inflammation of the occipital nerves, which run from the top of the spinal cord at the base of the neck up through the scalp. It causes sharp, stabbing, or electric shock-like pain in the back of the head, often radiating to the top of the head, behind the eyes, or toward the ears.
Occipital neuralgia is often misdiagnosed as tension or migraine headaches, but the condition has distinct features and responds well to targeted treatment.
Common Causes
Occipital neuralgia occurs when the greater or lesser occipital nerves are compressed, inflamed, or entrapped. Causes may include:
Neck muscle tension or spasm
Whiplash or cervical trauma
Arthritis or degenerative disc disease in the cervical spine
Tight headgear or sustained neck flexion (e.g., computer use)
Post-surgical or postural changes
Idiopathic (no clear structural cause)
Symptoms
Piercing, shock-like pain in the back of the head or upper neck
Pain may radiate to the scalp, behind the eyes, or ears
Tenderness over the occipital nerves
Episodes lasting from seconds to hours, often triggered by neck movement, touch, or pressure
Possible sensitivity to light and scalp discomfort
Conservative Treatment Options
Medications
NSAIDs or muscle relaxants to reduce inflammation and spasm
Neuropathic agents (e.g., gabapentin, pregabalin, or tricyclic antidepressants)
Botox injections for chronic or recurrent symptoms
Physical Therapy
Targeted cervical spine exercises to reduce nerve compression and muscle tension
Posture correction and ergonomic adjustments
Stress Management
Techniques like massage, mindfulness, and biofeedback can reduce frequency in tension-related cases
Interventional Treatment Options
If symptoms persist despite conservative care, interventional pain management may offer fast and effective relief:
Occipital Nerve Block
A targeted injection of anesthetic and steroid around the greater or lesser occipital nerve
Provides diagnostic and therapeutic benefit, often with immediate pain relief
Radiofrequency Ablation (RFA)
Uses heat to desensitize the occipital nerve, providing longer-term relief for patients who respond well to nerve blocks
Relief typically lasts 6–18 months
Peripheral Nerve Stimulation (PNS)
A small electrode is implanted near the occipital nerve to modulate pain signals
Effective for chronic, medication-resistant occipital neuralgia
Trigger Point Injections
Can be used when muscle tension contributes to nerve irritation
When to Consider a Specialist
Occipital neuralgia can mimic other headache disorders, making accurate diagnosis critical. If you experience:
Persistent pain unresponsive to over-the-counter medications
Pain triggered by light touch or neck movement
Pain relief after local anesthetic injection
...you may benefit from evaluation by a pain management or interventional spine specialist.
Find Relief with Targeted Treatment
Occipital neuralgia can be disabling—but with the right diagnosis and personalized treatment plan, long-term relief is within reach. At Parkview Spine & Pain, we specialize in advanced therapies that target the root cause of your pain.
👉 Contact us today to schedule your consultation and explore your options for lasting relief.