Occipital Neuralgia: A Common Cause of Headache

David S. Klein, MD FACA FACPM
Aug 25
4 min read

Occipital Neuralgia results from a nerve entrapment at the upper part of the neck. Causing pain in the back of the head and frequently over or behind the eye — Occipital Neuralgia results from a nerve entrapment at the upper part of the neck.

At Stages of Life Medical Institute, we meet patients every week who come to us with a puzzling and debilitating pain that starts at the base of the skull and radiates upward into the scalp or even behind the eye. This condition, called occipital neuralgia, is often mistaken for migraine or tension headache—but it has its own causes, diagnostic criteria, and effective treatments.

Often confused with migraine, Greater Occipital Neuralgia is caused by mechanical irritation, compression or damage to the delicate nerves that run from the base of the skull through the posterior, supportive muscles of the neck. The confusion with migraine begins with the overlap of symptoms between the two conditions, including intense pain, nausea, and eye pain.

Our goal is to first diagnose your condition with precision, and offer targeted therapies that restore quality of life while avoiding unnecessary interventions.

The occipital nerves run below the scalp and are easily damaged by being pinched by the muscles of the neck and may be crushed against the bone of the skull.

What is Occipital Neuralgia?

Occipital neuralgia is a common medical condition that arises when the greater, lesser, or third occipital nerves—which carry sensation from the upper neck and back of the head—become compressed or irritated.

Patients often describe:

Sharp, stabbing, “electric” jabs of pain lasting seconds to minutes.
A dull, lingering ache between flares.
Tenderness along the nerve’s path, often just below the skull.
Sensitivity to touch—even a pillow or a hat can trigger pain.

Why Does Occipital Neuralgia Happen?

The occipital nerves can be pinched as they weave through muscles and connective tissue in the neck. Common culprits include:

Postural strain (long hours at a computer, poor ergonomics).
Whiplash injuries, extension or rotational injuries of the head and neck.
Arthritis of the upper cervical spine (C2–C3).
Postsurgical scarring or muscular tightness.
Blunt trauma
We must differentiate greater occipital neuralgia from trigeminal neuralgia and other causes of occipital headache

How We Diagnose at Stages of Life

Our evaluation begins with a detailed history and hands-on examination. We look for hallmark signs such as nerve tenderness and pain triggered by light touch.

When the story and exam point toward occipital neuralgia, we first place the patient on anti-inflammatory medications, selected muscle relaxants and membrane stabilizing medications. We select from a variety of prescription and non-prescripotion choices, depending entirely on the clinical situation.

More times than not, this provides substantial relief. If necessary, we may decide to perform a diagnostic nerve block—injecting a small amount of numbing medicine around the nerve.

Immediate relief confirms the diagnosis. Sometimes we repeat the block to eliminate false positives. We also rule out mimics like migraine or cervicogenic headache, using imaging or further testing, only if there are red flags.

Treatment Options for Greater Occipital Neuralgia: Stepwise and Targeted

At Stages of Life, our philosophy is to start simple, then step up only as needed:

Lifestyle & Conservative Measures: Posture correction, ergonomic coaching, gentle neck rehabilitation, and sleep optimization.
Medications: Neuropathic agents (gabapentin, tricyclics) and nonsteroidal anti-inflammatories can help some patients.
Occipital Nerve Blocks: Both diagnostic and therapeutic, these injections often provide immediate relief. With ultrasound guidance, we maximize precision and safety.

Our Patient Journey

When you walk into Stages of Life Medical Institute, you can expect:

A thorough evaluation by a board-certified physician.
Clear explanations and reassurance.
Tailored treatment—starting with conservative steps and progressing to advanced interventions only when necessary.
Our services are performed in the office setting, minimizing collateral costs to the patient, we are located conveniently in our own office building with substantial available parking, close by.

Our integrative approach means that whether you need lifestyle coaching, targeted injections, or state-of-the-art neuromodulation, your care is anchored in compassion, precision, and science.

References:

Headache Classification Committee of the International Headache Society. “13.4 Occipital neuralgia.” ICHD-3 (2018). ichd-3.org ICHD-3
Djavaherian DM, et al. “Occipital Neuralgia.” StatPearls (updated 2023). NCBI Bookshelf NCBI
Austin M, et al. “Occipital Nerve Block.” StatPearls (updated 2023). NCBI Bookshelf NCBI
Shim JH, et al. “Ultrasound-guided greater occipital nerve block.” Korean J Anesthesiol 2011. PMC PMC
Barmherzig R, Kingston W. “Occipital Neuralgia and Cervicogenic Headache: Diagnosis and Management.” Curr Neurol Neurosci Rep 2019. PDF painschoolinternational.com
Scherer SS, et al. “The Greater Occipital Nerve and Obliquus Capitis Inferior.” Plast Reconstr Surg 2019. Journal site Lippincott Journals
Sağlam L, et al. “Morphological features of the greater occipital nerve and its muscular relations.” Surg Radiol Anat 2023. PMC PMC
Kim HS, et al. “Stereotactic topography of the greater and third occipital nerves.” Sci Rep 2018. Nature Nature
Juškys R, et al. “Effectiveness of treatment of occipital neuralgia using occipital nerve block.” Medicina (Kaunas) 2018. PMC PMC
Batistaki C, et al. “Pulsed Radiofrequency of the Occipital Nerves.” Pain Res Manag 2021. PMC PMC
De Oliveira K, et al. “Pulsed Radiofrequency Neuromodulation of the Greater Occipital Nerve: Systematic Review.” Can J Pain 2024. Taylor & Francis Taylor & Francis Online
Manolitsis N, Elahi F. “Pulsed Radiofrequency for Occipital Neuralgia: Review.” Pain Physician 2014. PDF Pain Physician Journal
Montenegro MM, et al. “Long-term outcomes of occipital nerve stimulation.” Headache 2023. PMC PMC
Lam KHS, et al. “Ultrasound-guided hydrodissection with 5% dextrose for occipital neuralgia.” Diagnostics 2024. MDPI MDPI
Ruberto N, et al. “Percutaneous peripheral nerve stimulation for occipital neuralgia (case report).” Orthopedic Reviews 2025. Open Medical Publishing Orthopedic Reviews