Occipital Neuralgia – What are the Symptoms?

“Occipital Neuralgia is a rare neurological condition in which the occipital nerves (the nerves that run through the scalp), are injured or inflamed. This causes headaches that feel like severe shooting, piercing, burning, throbbing, or shock-like pain in the upper neck, back of the head or behind the ears” [1, 2]. When you consult a Pain Doctor, in the first instance, they will look for abnormalities by conducting a physical examination and neurological exam, along with diagnostic imaging

Did You Know?

Are you aware that the medical term neuralgia, refers to a pain in a nerve pathway.

What Occipital Neuralgia Symptoms Should I Look Out For?

Symptoms include:
• Pain in the upper neck
• Pain at the back of the head
• Pain behind the ears and eyes (normally on one side of the head)
• Pain in the scalp
• Pain in the forehead [2]

Note: if you start to, or already experience any of the aforementioned symptoms, book an online or in-person with a Pain Consultant as soon as possible. Keeping a daily ‘Pain Diary,’ in which you can note down any symptoms, (as well as how long they last, and what you were doing at the time they came on), is an excellent strategy. That way, you can show it to your Pain Doctor, who will find it extremely helpful.

The Low-Down

Generally speaking, Pain Doctors find that a patient’s occipital neuralgia normally starts in the neck, and then extends upwards. Some sufferers describe their pain as similar to a migraine. The scalp can feel tender and highly sensitive to such a degree, that if it’s only touched very lightly, it can nonetheless, cause allodynia (pain caused by a stimulus that does not usually provoke pain). A good example of this, is a light feather touch (that should only generate a slight sensation).

So What Causes Occipital Neuralgia?

• A neck or head injury
• Pinched nerves
• Muscle tightness in the neck
• Over-tight neck muscles
• Nerve compression
• Disc Disease
• Infection
• Inflammation [1, 2]

Primary and Secondary Occipital Neuralgia

This condition can be classed as primary or secondary. The latter is linked to an underlying disease.
Whilst some of the causes on the following list can bring on occipital neuralgia; in a substantial number of cases, the conditions may be due to long-term neck tension, or unknown origins [1,2].
• Upper cervical spine osteoarthritis
• Trauma to the lessor and/or greater occipital nerves
• Compression of the lessor and/or greater occipital nerves or C2 and/or C3 nerve roots due to degenerative changes in the cervical spine
• Cervical disc disease
• Tumours that impact C2 and C3 nerve roots
• Inflammation of the blood vessels
• Diabetes
• Gout
• Infection [1,2]

Getting Things Sorted

Whether your occipital neuralgia symptoms are recent, or you have been suffering with them for a long time, the best course of action is to book a virtual or in-person appointment with a Pain Doctor as soon as possible. Once your Pain Consultant has reviewed your medical history, and asked you various pertinent questions, they will then arrange for you to have a physical and neurological examination, as well as diagnostic imaging. In order to help with the diagnosis, your Pain Specialist may use a nerve block (in which a steroid drug and local anaesthetic are injected into the area around the nerve in question). Once a diagnosis has been confirmed, you will then be given a Personalised Treatment Plan which is likely to include multiple types of treatment [2]


[1]. American Association of Neurological Surgeons (2024). “Occipital Neuralgia.”

[2]. National Institutes of Health (NIH): National Institutes of Neurological Disorders and Stroke (2023). “What is Occipital Neuralgia?”