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Occipital Neuralgia: Symptoms, Causes, Treatment, and Prevention

6 min read

By Hannah Stephens

  • Occipital neuralgia occurs due to inflammation or constriction of the occipital nerve between the top of the neck and the brain.
  • This condition isn’t life-threatening but can cause significant pain and discomfort.
  • The most common symptom of occipital neuralgia is burning, throbbing, or shooting pain across the back and top of the head and scalp.
  • It can be a sign of an underlying condition, such as osteoarthritis in the cervical spine.
  • Most people recover from occipital neuralgia with conservative management, but severe cases may require surgery.

Many people experiencing head pain assume they have a migraine or stress headache, but there are several less common types of headaches to be aware of. If you have burning or shooting pain that affects your scalp, occipital neuralgia could be a potential culprit.

Understanding what occipital neuralgia is can help you recognize the signs and seek the correct treatment. Below, we’ll explain what causes this condition, how it’s diagnosed, and the long-term outlook.

What Is Occipital Neuralgia?

Occipital neuralgia is a condition caused by irritated or inflamed occipital nerves. The occipital nerves travel in two branches from the top of the neck through the back of the head and scalp. They transmit sensation messages from the back and top of the head to the brain and can cause pain in these areas in people with occipital neuralgia.

Although occipital neuralgia can be very painful, it’s usually treatable. You can consult your healthcare provider to rule out alternative causes of your discomfort, obtain a formal diagnosis and discuss treatment options if you experience occipital neuralgia symptoms.

Occipital Neuralgia Symptoms

Occipital neuralgia symptoms are often similar to migraines or cluster headaches. The condition usually causes spreading or shooting pains from the top of the neck or base of the skull to the scalp, which can affect one or both sides of the head. Although the occipital nerves don’t extend to the eyes, they can cause referred pain behind the eyes.

Many people with occipital neuralgia describe the associated pain as a burning, throbbing, or “electric shock” sensation. The pain may be constant or come in sudden waves. Sometimes, the pain of occipital neuralgia can be debilitating and make it difficult to perform activities that involve touching your head, such as brushing your hair or lying on a pillow.

Occipital Neuralgia Causes

There are several potential causes of nerve irritation observed in people with occipital neuralgia. Often, occipital neuralgia is a sign of an underlying condition causing pressure on the occipital nerve. For example, arthritis or herniated discs in the top of your spine can irritate the occipital nerve where it branches from the upper neck to the head. Other conditions that could cause occipital neuralgia include:

  • Gout
  • Diabetes
  • Infection
  • Neck injuries
  • Tumors in the cervical spine
  • Vasculitis

However, muscle tension in the neck can sometimes cause occipital neuralgia without any other underlying illness or injury. Occasionally, there’s no apparent reason why a person develops the condition.

Occipital Neuralgia Diagnosis

There’s no single test used to diagnose occipital neuralgia. Often, doctors begin with a physical and neurological exam to look for signs of the condition and identify any underlying causes. Before diagnosing occipital neuralgia, they may also consider alternative diagnoses, such as migraines.

MRI and CT scans can sometimes help doctors make a diagnosis because they can show underlying issues placing pressure on the occipital nerves. Alternatively, your physician may recommend an occipital nerve block procedure, which involves injecting local anesthetic and steroid medication into the occipital nerve in an outpatient setting. This procedure can help confirm an occipital neuralgia diagnosis if it relieves your symptoms.

Nonsurgical Treatments for Occipital Neuralgia

Nonsurgical treatments for occipital neuralgia aim to reduce pain. Your doctor may recommend these more conservative options if the cause of your condition is temporary, such as an injury. Applying heating pads to the affected area and massage therapy can provide significant pain relief for some people. Your doctor may also prescribe physical therapy to help treat any mechanical cause of your occipital neuralgia.

If these techniques don’t work, you may require medication to control your symptoms. Healthcare providers sometimes prescribe muscle relaxants to reduce neck tension or anti-inflammatory drugs to ease pain and inflammation. An occipital nerve block procedure can significantly reduce discomfort if your symptoms don’t respond to oral medication.

Surgical Treatments for Occipital Neuralgia

If the occipital neuralgia is caused by an underlying health condition, some people may require surgery to correct it. There are also specific surgical procedures that can reduce the pain of occipital neuralgia, although your doctor is unlikely to recommend them unless you’ve tried nonsurgical treatments, and they haven’t worked.

Occipital nerve stimulation is a surgical technique that involves stimulating the occipital nerve with electrodes. This process can prevent pain messages from traveling along the nerve to your brain. Alternatively, your surgeon may apply the electrodes to the nerves in your spinal cord in a procedure known as spinal cord stimulation.

Occipital Neuralgia Prognosis

Occipital neuralgia isn’t dangerous and has no impact on your life expectancy, although it can be highly unpleasant to live with. Most people receiving conservative treatment start feeling better within a couple of weeks, although it can take up to 6-weeks for the nerves to heal if your condition is more severe.

The outlook may be somewhat different if you have an underlying long-term condition causing occipital neuralgia. In this situation, how long it takes you to recover may depend on which condition you have and how you treat it. Regardless of the cause, you may need to continue with physical therapy exercises or manage neck tension to prevent the condition from recurring.

Is Occipital Neuralgia Preventable?

Whether occipital neuralgia is preventable depends on the underlying cause. Maintaining a healthy lifestyle and weight could help you avoid some conditions that commonly cause occipital neuralgia, such as gout and type 2 diabetes. Addressing neck tension as soon as you notice it by applying a warm compress or visiting a massage therapist could also somewhat reduce your risk of occipital neuralgia.

Regularly stretching your neck by tucking your chin into your chest can sometimes prevent your symptoms from worsening if you already have occipital neuralgia. However, you should stop stretching and seek medical advice if this movement exacerbates your symptoms.

Who Is at Risk of Developing Occipital Neuralgia?

It’s challenging to determine the risk factors for developing occipital neuralgia because it’s associated with a wide range of other medical conditions. Generally, your risk is higher if you already have a condition known to cause occipital neuralgia in some people.

Experiencing an injury affecting the top of your spine could make developing occipital neuralgia more likely. You could also be at greater risk if you habitually tense the muscles in your neck. For example, some people involuntarily tighten their neck muscles in response to stress.

How Common Is Occipital Neuralgia?

It’s relatively unusual for occipital neuralgia to occur independently without an accompanying cause or another headache condition. The Barrow Neurological Institute estimates that only 3.2 people in every 100,000 experience occipital neuralgia as their only diagnosis without an underlying reason in any given year.

However, occipital neuralgia is significantly more common in people who experience migraines, cluster headaches, and other types of headaches. The total number of people living with occipital neuralgia alongside other diagnoses is unknown.

Occipital Neuralgia vs. Trigeminal Neuralgia

Occipital neuralgia has much in common with trigeminal neuralgia, another relatively unusual condition causing head pain. However, trigeminal neuralgia occurs due to irritation of the trigeminal nerve, causing facial pain. Although the type of pain caused by trigeminal neuralgia is similar to occipital neuralgia, it rarely affects the top or back of the head.

Trigeminal neuralgia generally has a different cause from occipital neuralgia. It can occur when a blood vessel impinges on the trigeminal nerve around the brain stem. Multiple sclerosis (MS) can also cause the condition because it causes a breakdown of the nerve’s protective sheath. Trigeminal neuralgia can begin at any age but is more common in people aged 50 or older.

When to See a Doctor

Occipital neuralgia is rarely a sign of a medical emergency, but consulting your doctor can help you manage your pain and check for underlying health conditions. If you already have a migraine diagnosis, you should seek medical advice if you experience head pain without your usual accompanying symptoms, such as aura or nausea.

Occasionally, neck and head pain can signify a serious health problem. Seek urgent care if you experience the following symptoms, even if you believe you have occipital neuralgia:

  • Fever
  • Visual disturbances, such as double vision or complete vision loss
  • Confusion
  • Slurred speech
  • Sudden numbness or weakness in any part of your body.

Hannah Stephens


Hannah Stephens lives in Kent in the United Kingdom with her husband and young son. She is a qualified elementary teacher and has been working as a commercial writer for over four years. When she's not busy creating content, Hannah enjoys cooking, learning new languages, and walking in the beautiful countryside near her home.

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