Sharp, shooting, electric pain at the back of the head, following the occipital nerves.
What is occipital neuralgia?
The greater and lesser occipital nerves run from the upper neck over the back of the skull. When they get irritated or pinched, they cause a telltale electric pain.
It is common after whiplash. It also comes from tight muscles trapping the nerve and from arthritis in the upper neck.
What are the first symptoms of occipital neuralgia?
- Sudden shooting pain from the base of the skull toward the crown.
- A tender spot where the nerve crosses the skull.
- A sore scalp. Brushing your hair or lying on a pillow hurts.
- Usually one-sided.
How is occipital neuralgia treated?
- Occipital nerve block. It usually tests for the problem and treats it at the same time.
- Nerve pain medication.
- Treatment of the upper neck when it is the root cause.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
The key feature is what the pain feels like, not where it is. It is brief, electric and shooting, and lasts seconds. There is a tender spot where the nerve crosses the skull. A steady ache at the back of the head is more likely cervicogenic (coming from the neck) than from the nerve.
It gets missed when a sore scalp is blamed on tension. Allodynia means pain from a touch that should not hurt, like brushing hair or resting on a pillow. It is a nerve sign, not a muscle sign. It points straight at the occipital nerve.
What is the outlook for occipital neuralgia?
Occipital nerve block both tests for the problem and treats it. Relief frequently outlasts the anesthetic by weeks or months. If it comes back, the block can be repeated, or the neck problem underneath can be treated.
Persistent cases respond to pulsed radiofrequency or, occasionally, peripheral nerve stimulation. Surgical decompression (surgery to free the nerve) is rarely needed. It is not a first choice.
When this becomes urgent
Sudden severe pain at the back of the head, especially if it starts all at once, needs emergency care to rule out bleeding. Pain at the back of the head with fever and a stiff neck, or with vision symptoms in someone over fifty, also needs urgent review.
Related: brief electric pain in the face, not at the back of the head, points to trigeminal neuralgia.
What causes occipital neuralgia?
The greater and lesser occipital nerves run from the upper neck to the scalp. If they get irritated or pinched along that path, you get sharp, shooting or electric pain over the back of the head. It is often on one side. Between attacks, the scalp stays sore, so brushing hair or resting on a pillow is uncomfortable.
What it gets confused with
It is often diagnosed as migraine, and the two can happen together. What sets it apart is the sharp electric feel, the tender spot over the nerve at the base of the skull, and the response to an occipital nerve block. That block is both a diagnostic test and a treatment.
The metabolic side
Poorly controlled blood sugar, low vitamin D and a constant inflammatory load all measurably slow tissue repair. Pain that will not settle sometimes has a reason outside the part being treated. We check these when they matter. We treat them alongside the structural work, not instead of it.
Frequently asked questions
Is this dangerous?
No. It is painful and easy to recognize, and it responds well to a targeted block.
Why does my scalp hurt between attacks?
The nerve becomes oversensitive, so the scalp hurts with ordinary touch. That is a known part of the condition, not something separate.
Occipital Nerve Block covers the block that treats it.
How is it distinguished from migraine?
By what the pain feels like and where it is, a tender spot over the nerve, and the response to a diagnostic block. The two can also happen together.
Cervicogenic Headache covers the neck-driven headache that is also mistaken for migraine.
How is occipital neuralgia diagnosed?
By what the pain feels like and a hands-on exam. The pain is brief, electric and shooting, and lasts seconds. There is a tender spot where the nerve crosses the skull, and the scalp hurts to light touch. An occipital nerve block then settles it. If numbing the nerve stops the pain, the nerve is the source, and the same block starts treatment.
How do you make occipital neuralgia go away?
An occipital nerve block is the first step, and relief often outlasts the numbing medicine by weeks or months. If the pain comes back, the block can be repeated or the upper neck problem driving it can be treated. Persistent cases respond to pulsed radiofrequency or, occasionally, peripheral nerve stimulation. Surgery is rarely necessary and is never the first step.
When should I see a doctor for occipital neuralgia?
Book a visit when sharp, electric pain at the back of the head keeps coming back, or when brushing your hair or lying on a pillow hurts. Go for emergency care instead for sudden, severe pain at the back of the head, especially if it starts all at once, for pain with fever and a stiff neck, or for vision symptoms in anyone over fifty.
Sources
- Pan W et al. Occipital Neuralgia. Current pain and headache reports, 2021. PubMed 34287719
- Lefel N et al. 11. Cervicogenic headache and occipital neuralgia. Pain practice : the official journal of World Institute of Pain, 2025. PubMed 39219023
- Dougherty C. Occipital neuralgia. Current pain and headache reports, 2014. PubMed 24737457
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.