The sudden shooting pain in the back of the head may be mistaken for an unusual headache. It may start at the neck, move upward across the scalp and sometimes even reach the area behind the eye. Even touching the head and resting the back of the head in a pillow can be painful for some people. These symptoms could be associated with occipital neuralgia, the occipital nerves that give sensation to most parts of the back and top of the head. While occipital neuralgia can be analogous to migraines and other headache disorders, it is important to understand where the pain starts and how it behaves so you are able to know when to seek medical attention.
What is occipital neuralgia?
Occipital neuralgia occurs when one or more of the occipital nerves become irritated or injured. These nerves originate near the upper neck and progress upward on the back of the scalp.
At the same time the greater and lesser occipital nerves are responsible for much of the feeling in large portions of the scalp. When nerves get irritated, pain can follow their path.
Unlike the steady pressure that we typically associate with a tension headache, occipital neuralgia is often described as sharp, shooting, piercing or electric. Pain may be brief and then persist and be sore or tender between episodes.
Symptoms can be on one side of the head or both.
Why does pain go up to the head?
The location of the occipital nerves is one of the most obvious features of the condition. When the nerves come from the head to the scalp, irritation can cause pain along the same path.
Someone might first feel discomfort near the base of the skull before suffering pain that goes upwards. Pain may begin at the top of the head or behind an eye.
The scalp might appear to be particularly sensitive. Brushing the hair, touching the head, wearing a hat or resting the head on a pillow can lead to discomfort.
This type of pattern can be of great aid to a medical assessment but symptoms alone cannot help you diagnose it.
What causes Occipital Neuralgia?
Occipital neuralgia does not always have one cause. The occipital nerves can be irritated by tight muscles or other structures in the neck. Neck injuries can also cause symptoms in some patients.
Conditions affecting the cervical spine can occasionally cause pain, and inflammation or compression around a nerve may cause pain.
In other cases, there may not be a discernible cause.
That is why medical evaluation is so important. However, a healthcare professional must consider the patient’s symptoms, medical history and physical examination and not assume that every sharp pain on the back of the head is occipital neuralgia.
Is it Occipital Neuralgia or Migraine?
Occipital neuralgia and migraine can be difficult to distinguish. Migraine can cause a lot of head pain and sensitivity around the scalp. Some migraine patients also experience neck pain and are at risk of nausea and may also be sensitive to light or sound.
Occipital neuralgia typically causes pain along the pathway of the occipital nerves and tends to begin from the upper neck and the base of the skull. Sharp or electric symptoms and tenderness over the affected nerve may be present as well.
But symptoms can overlap and a person can have more than one headache or pain condition.
That makes self-diagnosis difficult. A doctor might have to look into migraine, tension-type headaches, cervical problems and other possible causes before determining what is causing the pain.
How Is Occipital Neuralgia Diagnosed?
There isn’t a test that provides the answer immediately in every case. A doctor may start by asking where the pain starts, where it travels, what it feels like and how long it lasts. The patient may also be asked about the last time they had a head injury or headaches.
The doctor may assess the neck and scalp and check for tenderness around the occipital nerves during a physical examination, and imaging or other testing may be recommended if there is a reason for the pain or other causes.
A diagnostic nerve block might also be considered. If temporarily numbing an occipital nerve significantly reduces the characteristic pain, that response can give more information to the treating physician.
How is Occipital Neuralgia treated?
The treatment is dependent on the suspected cause, severity and frequency. Some patients might feel the need to first go very conservatively.
Heat or physical therapy or other treatments to relieve muscle tension and improve neck function can be used when necessary.
Medications may also be applied according to the patient’s symptoms and medical history. Because nerve pain can behave differently from other types of pain, the medication used may not be the same for a headache that is relatively common for people.
Patients should discuss medication use with a healthcare professional rather than repeatedly taking over-the-counter pain medicine on their own.
What is an Occipital Nerve Block?
An occipital nerve block is one of the treatments that can be used in the evaluation or management of occipital neuralgia.
Medication is injected into an occipital nerve during the procedure. A local anesthetic is usually applied, and other medication may be added depending on the treatment plan.
The objective is to stop the pain signals from the affected nerve and relieve pain.
The duration of relief varies. Some patients may be relatively well for a short period of time and others may require treatment if symptoms are still present.
A nerve block can also be diagnostic because a nerve block can also be helpful for the patient’s responses, as the patient’s response can be used to determine whether the occipital nerve is a component of the pain.
What happens if the Pain Keeps Coming Back?
Occipital neuralgia may require a more detailed treatment plan. An expert may consider other interventions if conservative actions and nerve blocks fail to provide enough relief.
The right treatment is based on what is causing the nerve irritation in the first place and how the patient has responded to prior treatment.
Pain management that is more invasive is not the first step for every patient. We will find the cause of the symptoms and adapt to the extent of the pain and the duration of the disease.
When Should Head Pain Be Evaluated?
Pain at the back of the head that is recurring and unexplained should be evaluated and should not interfere with sleep, work or daily life.
Not every severe headache should be regarded as occipital neuralgia. A sudden and severe headache, new neurological symptoms, weakness, confusion, fainting, significant vision changes, fever with neck stiffness or head pain following a serious injury can require immediate and emergency treatment.
Additionally, a new headache or substantially different headache should be discussed with a healthcare professional.
Conclusion
Occipital neuralgia can create a signature sharp, shooting or electric pain with a pattern that starts at the upper neck or the base of the skull and goes across the scalp. Given that its symptoms can overlap with migraine and other headache disorders, the identification of the cause of the pain is the most important aspect of treatment. Conservative care, medication, physical therapy and occipital nerve blocks in the case of a person with recurrent headaches may be considered depending on their individual case, and persistent symptoms may need further evaluation. Understanding how occipital neuralgia functions might help patients recognize that what seems like an unusual headache is probably nerves at the back of the head.
