12 Of The Most Common Occipital Neuralgia Symptoms – Pain Doctor (2024)

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You’re experiencing intense head pain, but you’re not sure if it’s a headache, migraine, or a lesser-known condition called occipital neuralgia. What are the most common occipital neuralgia symptoms that can lead to a correct diagnosis? We discuss 12 of the leading symptoms, and also talk about how this condition differs from migraines and headaches.

What causes occipital neuralgia?

Its symptoms are similar to headache, but occipital neuralgia has a distinct origin that is often quite different than typical headaches and migraines. Occipital neuralgia is caused by irritation, inflammation, or injury to the occipital nerves. The occipital nerves run up from the base of the neck to the back of the skull, as shown below.

John Hopkins Medicine explains how these enervate the head:

“Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. There is one nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. They sometimes reach nearly as far forward as the forehead, but do not cover the face or the area near the ears; other nerves supply these regions.”

Occipital neuralgia occurs when these nerves are damaged. Most often, an isolated incident is to blame. Considerable trauma or injury to the head or neck can damage these nerves. This often occurs in a car accident or some other injury that causes whiplash.

Other common causes include overly tight neck muscles, arthritis, and diabetes. You can learn more about each of these in our post “8 Of The Most Common Causes Of Occipital Neuralgia.”

Since there are very specific occipital neuralgia causes, this condition is often confused with migraines or other severe headaches. True occipital neuralgia is rare. The American Migraine Foundation estimates that only 3.2 people out of 100,000 actually suffer from this condition. The following video talks about occipital neuralgia symptoms and causes in more detail.

What are the most common occipital neuralgia symptoms?

To determine if you’re suffering from occipital neuralgia vs migraine or other types of headaches, it’s important to look at the symptoms of occipital neuralgia.

The most common occipital neuralgia symptoms include:

1. Sudden, severe, and sharp head pain
2. Pain that occurs most commonly behind the eye, at the base of the head, and on one side of the head
3. Sensitivity to light
4. Scalp tenderness
5. Blurry vision
6. Dizziness
7. Vertigo
8. Slurred speech
9. Nausea
10. Vomiting
11. Tightness and pain in the neck
12. Dental pain

Let’s talk about these occipital neuralgia symptoms in more detail.

Pain

Pain is the most characteristic symptom of occipital neuralgia, and often the most debilitating for patients. But pain, in and of itself, is a broad term. Occipital neuralgia pain in particular is often described as:

• Episodic
• Shocking
• Shooting
• Radiating
• Aching
• Burning
• Throbbing
• Intense
• Piercing
• Stabbing
• Sharp
• Spasms

While migraine sufferers may deal with dull and aching pain that doesn’t go away, occipital neuralgia produces a much more intense and (typically) shorter period of pain. Most commonly, this pain is felt most commonly:

• Along the occipital nerves
• At the base of the head, where the neck meets the skull
• On the back of the head
• Oftentimes on one side of the head, though it can also be bilateral (or both sides)
• Behind one eye

All patients will experience this pain differently, however. Some do experience more throbbing, dull pain, while others feel pain and tenderness on the sides of the head or even forehead. Many patients may only feel pain for a few seconds, or a few minutes.

Sensitivity

Sensitivity, in multiple forms, is another one of the most characteristic occipital neuralgia symptoms.

If you’re suffering from occipital neuralgia, you’ll typically feel severe tenderness directly over the affected occipital nerves. When these areas are touched or compressed, pain will flare up. This sensitivity might only last for a few seconds, but nerves often stay tender afterwards. One of the main ways doctors diagnose this condition is by palpating these areas, since it can help them determine if occipital neuralgia or migraines are leading to your pain.

As the American Association of Neurological Surgeons explains, this tenderness can directly impact multiple facets of your life. They note that: “The scalp may be tender to the touch, and an activity like brushing the hair may increase a person’s pain.” Other activities that cause pain include laying down on a pillow, turning the head to the side, or moving the neck.

Beyond touch sensitivity, many with this condition also experience light sensitivity.

Balance and coordination issues

Like migraine, occipital neuralgia symptoms also include those that affect balance and coordination.

These include:

• Vision issues, such as blurry eyes
• Vertigo
• Dizziness
• Nausea (and vomiting in severe cases)
• Slurred speech

Referred pain

Finally, the human body is a complex organism. Pain, especially severe pain, in one area can affect and lead to pain in other areas.

Those with occipital neuralgia often experience increased neck pain, especially when moving the head. They may also feel tightness, stiffness, or spasms in the neck.

Likewise, they may also experience dental pain or pain around the mouth and jaw.

How can I tell the difference between a headache or migraine vs. occipital neuralgia?

Occipital neuralgia is a rare condition, but when it does occur, it’s most often misdiagnosed at first. Conditions that share many of the same symptoms include:

• Migraines
• Tension headaches
• Cluster headaches
• Trigeminal neuralgia

There are a few tells that can help you determine if you’re suffering from occipital neuralgia or another headache disorder, most notably migraines. However, do note that these differences can only be used in a general manner. Everyone will experience pain differently, so it’s always best to talk to a certified pain specialist to get a correct diagnosis. Misdiagnosing the cause of your pain can lead to ineffective treatments and sustained pain.

The major differences between migraines vs occipital neuralgia include:

• Type of pain: Migraine pain is most often dull, throbbing, and occurs over a few hours; occipital neuralgia pain is typically episodic, sharp, and intense for short bursts of time
• Location of pain: Occipital neuralgia sufferers will experience pain upon palpation of the occipital nerves; this may or may not occur for migraine patients
• Vision symptoms: Both cause vision issues, but eye watering and redness is more characteristic of other headaches, while occipital neuralgia tends to produce blurry vision or pain behind the eyes
• Pain triggers:Migraines, in particular, often have known triggers, like light, certain smells or foods, or stress; occipital neuralgia most often occurs when turning or moving the head

To determine if you’re suffering from one condition or the other, start by keeping a pain diary today. This is an invaluable tool that helps you clearly explain to your doctor the symptoms you’re experiencing. We talk about some of the best options in “29 Of The Best Chronic Pain Apps.”

How do you treat occipital neuralgia?

Treatment starts with diagnosis, continues with preventative efforts, and includes both interventional and complementary therapies to treat pain.

Your doctor can determine if you have this condition by:

• Reviewing the notes and potential triggers you noted in your pain diary
• Conducting a thorough physical exam, including palpation of the occipital nerve area
• Ordering other diagnostic tests as needed, such as MRIs, CT scans, X-rays, or blood tests
• Performing a diagnostic occipital nerve block (that can also be used therapeutically, as the following video discusses)

Once you’ve realized that you have occipital neuralgia, there are proven treatments that can help. Occipital neuralgia is a debilitating and painful condition, but it isn’t life-threatening. Through a combination of therapies you can manage and prevent most of the pain associated with this condition. As Medical News Today explains: “The aim is to provide many people with relief by relaxing and releasing the muscles that are putting pressure on the occipital nerves.”

We talk about all of your treatment options (at-home, complementary, medications, and interventional) in “How To Treat Occipital Neuralgia: 21 Of The Best Methods.” Visit that post for an in-depth discussion of treatments and therapy approaches.

If you think you’re suffering from occipital neuralgia symptoms, it’s time to talk to a pain specialist. Because this is a more complex and rare condition, they’re equipped to lead diagnosis efforts and present different treatment approaches. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here.

1. 

   Susan StilesJanuary 26, 2018 at 11:51 am

   I was first diagnosed with peripheral neuropathy. My pain was so crippling that I quit my job and was approved for disability. I then was diagnosed with fibromyalgia and diabetes which over time made me bed bound. I injured my leg and had to amputate it. I feel like I’m dying in slow motion. I have been seeing a pain doctor since 2000 who has given me oxycontin, tizanidine, oxycodone, Lyrica, Cymbalta, Amitiza. For diabetes I take Lantus, metformin, glipizide. I only leave the house for church (if a nice day, if my pain is not critical), doctor’s appointment, or holiday family get togethers. I live with my son and receive no other help. It is such a disappointment to live this way but I don’t know of a more involved way to live. If you as a doctor have any suggestions for a better way to live, please let me know. I’m 64 and I feel like my life is short. Thank you. Susan Stiles

   • 

     Pain DoctorJanuary 29, 2018 at 11:53 am

     Hi Susan, we are so sorry to hear that. First, we suggest reaching out to a support group. Talking with people who are going through the same thing as you can help you find that support you truly need with a chronic condition. You can find options for those here: http://paindoctor.com/chronic-pain-support-groups/. From there, make sure to subscribe to the Pain Doctor blog. Twice a week, we cover tips for living a full life with pain. Sending good vibes your way!

2. 

   Anne SenatoreJune 9, 2018 at 4:54 pm

   I am in such pain, burning, pinching, nausea and headaches. I’ve tried medications for nerve pain and have had two nerve blocks. Nothing helps. I’m so desperate for some direction. Thank you

   • 

     Pain DoctorJune 11, 2018 at 12:51 pm

     Hi Anne — Unfortunately we can’t answer specific medical questions on the blog. We recommend reaching out to a doctor in your area: http://paindoctor.com/get-relief-now/ or using the tips here to find one: http://paindoctor.com/pain-management-doctors/. Hope that helps!

3. 

   LeeJune 14, 2018 at 2:10 pm

   I have occipital neuralgia,. I wish it only lasted for a minute or so. Yesterday i had one. It lasted 12 hours, I screamed so loud that I felt my ear drum bust. It will start at the base of my neck. Slowly, and at a low burn, it may take 2 days to work it’s way up my neck. THEN SOMEONE is driving a Hot poker right in the top of my head, and right above my ear through my head. All you can do is scream, your eye hurts, and you really have no idea where to put the ice. There us NOTHING, not one thing except Durning a attack toradol with a big muscle relaxers in a iv. And if your lucky pain blockers in the base of your neck, I had had that done day before yesterday, and the occipital neuralgia the next day, it’s trying to come back now. And if I find any thing at all I think will stop the pain, I will eat every pill I can find, I have sat in bed and have ate number 10 hydro untill someone took them away. It never stopped the pain and there was no way it would knock me out. It is horrible. And most people who have TBI have this, but it’s not known well enough for doctors to know about it. So we suffer. And get filled full of steroids in iv’s. I was given 86 rounds of steroids like this in one year. Because this evil pain made my white blood cell count high. So it can last from one minute to 2 weeks or more. I have done it. I feel sorry for anyone who has to live with this, I would rather have labor pains. I could at least breath and tell someone what I needed,

   • 

     Pain DoctorJune 18, 2018 at 4:43 pm

     Hi Lee — We are so sorry to hear about the challenges and pain you’ve had. Thank you for sharing your story with others.

4. 

   Robert LetourneauJuly 25, 2018 at 9:25 pm

   My name is bob L
   I have occipitial neuralgia bilateral more on the left. For 3.5 years now. It started with little twiching type spasums, now its fully blown out of proportion, the drs have known for a while i have had it. this is truly the devils gift the pain goes from 5 to 10 without warning 90 %of the time a load scream will follow and now have to grab my head with my hands. Cant sleep the pill somewhat hold it back but not nearly enough to make a real difference. the only difference it help is the amount of time i have spaums .i do know everyone is doing there best to help, however, i had to leave my work because im very sick over all the treatments that only work a short while. But because i was in a car accident im having trouble with my works insurance companies. Have to stop

   • 

     Pain DoctorJuly 29, 2018 at 12:13 pm

     Hi Robert — It sounds like you’re facing a lot. We recommend reaching out to a pain specialist by using the tips here: http://paindoctor.com/pain-management-doctors/.

     Also, chronic pain can have very real and severe effects on mental health. Reaching out to a therapist or chronic pain support group is vital while suffering from this: http://paindoctor.com/free-therapy-online/ and http://paindoctor.com/chronic-pain-support-groups/.

     This post may also have more helpful info on how you can apply for disability with chronic pain if you’re no longer able to work: http://paindoctor.com/is-chronic-pain-a-disability/. Wishing you the best.

     See Also

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5. 

   HeatherSeptember 4, 2018 at 7:09 am

   I am a 45 year old female.I have pain that I can not even explain other than like I am being shocked. I have had it in my gums, under my jaw near the front of my neck, in my eye, but most often in my ear or behind my ear. It only lasts a few seconds at time except today I have pretty constant sharp (not as bad as the the pain that comes on for a few seconds) pain.I have muscle spams all over my body (most often the face) for years. I do not know what is causing this? I am a nurse and have been recently researching and think it is a neuralgia . Do these symptoms sound as if this is possible?

6. 

   DianaJanuary 5, 2019 at 3:33 am

   I just experienced my first Occipital Neuralgia at 60 yr, beyond chronic pain, targeted behind my left ear and the base of my neck, not knowing what it was I dealt with it for 24 hours then went to the ER tears streaming down my face.. Treated with Toradol which was very effective. After 12 hrs I was nearly pain free only for it to resurface 6 hrs later waking me from a nights sleep, so I put a heated rice sock at the base of my neck, took 2 advil, very relieving. Still have a dull headache but I’ll take it over the later. My job is data entry so I’m sure it’s what has caused this issue, I’ll do some ergonomics soon as I get back to work. I’ll be looking for some neck exercises to strengthen those neck muscles as well as taking a look at the pillow I sleep on which is a high/low memory foam. The Pain Doctor website is uplifting and informative on this subject, there is a video of 3 yoga exercises that look good, some pillow talk, I’ll be doing a lot of self help and hopefully rid myself of this debilitating issue, if that is possible. If anyone has discovered anything that could be more relieving please let me know.

   • 

     Pain DoctorJanuary 7, 2019 at 10:54 am

     Thanks for your comments Diana!

7. 

   AcJanuary 31, 2019 at 11:30 pm

   Another few symptoms you can add is, when getting up from bed after a rest, the base of the skull in the back starts pounding. Or getting up from any rest makes the back of the head pound.

   Pain can be in either eye at times, it is sore for a few days then back to normal.

   A ridiculously itchy sensation as well in either eye.

   Also not sure if its because of occipital neuralgia but a strong itchy sensation in nose making me sneeze sometimes.

   Left eye often red and nose plugged, probably because of my failed self adjustments. Not sure.

   This article pretty much nails it. Ive never been diagnosed and just figured it out my own. I unsuccessfully tried to adjust my neck thinking I could make it better. Symptoms got worse. Flushed in face, anxiety through the roof, it was bad, those severe symptoms went away after a few weeks. I wont be self adjusting again. I dont recommend you do any self adjustments. If you do go to a chiropractor, a nucca will be your best bet. Most others dont know what they are doing. Except that Australian guy, I’m sure he is good.

   Change your pillows, stretch, etc. Find what works for you.

   Good article.

   Where did you get this information from?

   • 

     Pain DoctorFebruary 4, 2019 at 5:21 pm

     Thanks for sharing your symptoms!

8. 

   Beverly DuBoseMarch 19, 2019 at 3:54 pm

   Hi, I had cataract surgery in September and the day after the surgery the pain hit my head. One spot, right on top over the right eye, that had just had the lens replaced. I have been from eye doctor to eye doctor and no one has any answers. I wondered if the new lens was sitting on a nerve that connects to the top of my head. It is tender and is straight up from where the ear and eye connect about the size of a half dollar. It feels like someone is pounding a nail down through the to of my head. This has consumed my life and taken away my ability to participate in life. I spend a lot of time holding my head with the tips of my fingers and crying out and asking God why why why. Then I can take 2 hydrocodone and it goes away after about 30 minutes, to last around 3 hours and then back again. My eye feels like there is a bit of a sharp pain right in the middle of it, but I can handle that….. It is the top of my head that knocks me down to an ice pack and crying out.

   • 

     Pain DoctorMarch 25, 2019 at 12:55 pm

     Hi Beverly — We are so sorry to hear about the challenges you’ve had. Unfortunately we can’t answer specific medical questions on the blog. We recommend reaching out to your doctor with your questions. If you don’t already have one or want a second opinion, you can find a pain doctor in your area here: http://paindoctor.com/get-relief-now/ or use the tips here to find one: http://paindoctor.com/pain-management-doctors/.

9. 

   WaisumMarch 22, 2019 at 5:24 am

   Hi everyone,

   I have yet to be official diagnosed with occipital neuralgia but after all these years of chronic neck pain and now recently experiencing random electric shock like excruciating pain that causes serious eye and scalp pain which seems to be originated from neck movement. I think I do but thanks to the lack of belief and not being taken seriously by my gp. Looks like it will take much longer because I can get help from professional doctors.

   • 

     Pain DoctorMarch 25, 2019 at 12:54 pm

     Hi Waisum — Wishing you luck on finding a diagnosis for the cause of your pain. If you’re looking for a pain specialist who can help, you can use the tips here to find one: http://paindoctor.com/pain-management-doctors/.

10. 

    Jaimee LeighApril 23, 2019 at 5:44 pm

    I had concussion 4 months ago (December 2018). My neurologist told me I have an occipital neuralgia.
    I bumped my head while getting off airplane yesterday (April 2019) (stood up and forgot to bend down). I m not sure if my sculp is too sensitive , due to damaged occipital nerve or do I have another concussion.
    My head hurts so badly, but I can’t believe I had concossion from minor bang in a head.
    Can occipital neuralgia make your head overly sensitive to any bump?

    • 

      Pain DoctorApril 29, 2019 at 3:41 pm

      Hi Jaimee — We are so sorry to hear about the challenges you’ve had. Unfortunately we can’t answer specific medical questions on the blog. We recommend reaching out to your doctor with your questions. If you don’t already have one or want a second opinion, you can find a pain doctor in your area here: http://paindoctor.com/get-relief-now/ or use the tips here to find one: http://paindoctor.com/pain-management-doctors/.

11. 

    Gordon LachanceJune 26, 2019 at 6:07 pm

    I’ve been suffering now for 6 months and have no idea if its ON or not. I have constant headaches. Always dull. Never pounding. But the ache is just non stop. And my neck hurts around C3-C4 and up. All day every day it snaps and pops. The joints are tender. The muscles of my neck are sore to the touch, specifically the SCM and the muscle behind it (The trap insertion?).

    Now my trapezius muscles are starting to feel tight and sore. I have to keep shrugging them, and everytime I do they pop and it releases the tension.

    My neuro gave my nerve blocks in the base of my skull, but I still got the headaches and still felt the achey neck pain. All the MRIs and Xrays say my neck is fine.

    Could be it a torn muscle in my neck??? Im at my wits end, we cant figure out what this is. Im TERRIFIED of this becoming worse. Right now its always a dull ache, which is bad enough, but I dont want it to become a sharp, shooting pain thing

    • 

      Pain DoctorJuly 1, 2019 at 2:53 pm

      Hi Gordon — We are so sorry to hear about the challenges you’ve had. Unfortunately we can’t answer specific medical questions on the blog. We recommend reaching out to your doctor with your questions. If you don’t already have one or want a second opinion, you can find a pain doctor in your area here: http://paindoctor.com/get-relief-now/ or use the tips here to find one: http://paindoctor.com/pain-management-doctors/.

12. 

    Lee KJune 30, 2019 at 9:35 am

    Hi, i have had chronic neck and head pain for over forty years. The initial cause was a skull fracture and spinal damage form a car crash. Currently I have a mixture of symptoms with facial neuralgia being the most prominent for the last two days; hyper-sensitivity on the left side of the face. I take multiple medications, after many years and much complex calibration of dosage. Life is still no bed of roses, but most of the thorns are well managed.

    I am adding this note to reccomend a form of treatment that has made an enormous difference to me over thelast few years. it’s called Cranial Osteopathy. Chiropracters are far too rough in adjusting a damagd neck, but I have found an Osteopath whose gentle, subtle adjustments made an enormous and permanent change to my condition. His cranial osteopathy involved gently expanding the skull from the ridges above the neck, which were so damaged they caused pituitary failure some years ago, the pituitary being located deep in the brain above the base of the skull, and causing multiple endocrine problems.

    I still see him occasionally to adjust my spine and neck when my active life causes problems for a damaged skelal structure. I thoroughly reccomend osteopathy for spinal and skull based pain conditions. If you are in Australia you’ll find an excellent clinic in Canberra, ACT.

    • 

      Pain DoctorJuly 1, 2019 at 2:53 pm

      Thanks for sharing your experience here!

13. 

    Carlos ginerJuly 12, 2019 at 4:05 pm

    I’m not sure if I have occipital neuralgia but I have a rock hard bump on the right side of my skull ( the back of my skull) and is tender to the touch any idea what this could be? And if I should get diagnosed or just ice it? Anything helps Thankyou !

    • 

      Pain DoctorJuly 15, 2019 at 11:08 am

      Hi Carlos — Unfortunately we can’t answer specific medical questions on the blog, but we recommend reaching out to your doctor with your questions or for a diagnosis.