It is nerve pain in the territory of the occipital nerves, felt as sharp shooting or electric bursts running from the base of the skull up the back of the head. Occipital neuralgia is defined by where the pain travels and by its character, which is what separates it from a headache that simply hurts at the back.
It also gets confused with the scalp tenderness of a migraine attack, which is a different thing entirely. Our note on why the scalp hurts during a migraine covers that other mechanism.
Medical Disclaimer
This article is general information about a nerve pain condition. It is not medical advice, a diagnosis, or a treatment plan. Pain at the back of the head has several possible causes, some of them requiring prompt assessment. Only a clinician can determine what is producing yours.
Quick Answer
The occipital nerves run from the upper neck up the back of the scalp. When irritated or compressed they produce sharp, stabbing or electric pain in bursts, often with a persistent ache between them and a tender spot at the base of the skull. Pressing that spot commonly reproduces the pain.
Key Points
- The pain follows a nerve path rather than sitting in a general region.
- The character is shooting or electric, not throbbing and not merely tender.
- A tender point at the base of the skull that reproduces the pain is a key sign.
- It can refer forward behind the eye, which is why migraine gets suspected.
- Migraine allodynia is diffuse tenderness, a different mechanism entirely.
- A nerve block that relieves the pain supports the diagnosis.
- Many cases have no identifiable underlying cause.
| Feature | Occipital neuralgia | Migraine scalp tenderness |
|---|---|---|
| Pain character | Sharp, shooting, electric bursts | Soreness when touched |
| What sets it off | Neck movement, pressure on the nerve point | Any light touch, during an attack |
| Distribution | Follows the nerve path up the scalp | Diffuse over the painful side |
| Timing | Can occur between and outside attacks | Builds during an attack, eases after |
| Tender point | A specific spot at the base of the skull | No single point |
| Mechanism | Irritation of a peripheral nerve | Central sensitization |
| Response to a nerve block | Often relieved | Not the relevant treatment |
Where the Occipital Nerves Run
Three nerves matter here, commonly described as the greater, lesser and third occipital nerves. They arise from the upper cervical region and travel upward through the muscles at the base of the skull.
From there they supply sensation to the back and sides of the scalp, reaching as far forward as the top of the head in some people.
The National Institute of Neurological Disorders and Stroke describes occipital neuralgia as a distinct headache disorder arising from injury or irritation of these nerves, with pain in the back of the head and upper neck.
Knowing the route matters because it explains the distribution. Pain that travels in a band from the base of the skull upward is following a nerve. Pain that fills a whole side without a path is not.
What the Pain Actually Feels Like
Bursts rather than a build
The characteristic pain arrives in sudden sharp episodes, often described as stabbing, shooting, or like an electric shock. It does not build gradually the way a migraine does.
An ache in between
Between bursts many people report a continuing duller ache in the same territory, which is why the condition can feel constant with spikes on top.
Tenderness along the path
The scalp over the affected nerve is often sore, and brushing hair or resting on a pillow can be uncomfortable in that band specifically.
Referral behind the eye
Pain can be felt behind the eye on the same side, which is a well recognized feature and one of the main reasons migraine is suspected first.
Why It Is Not the Same as Migraine Allodynia
This distinction is worth spelling out, because both involve a tender scalp and both are one-sided.
Allodynia during a migraine attack is central sensitization. Pain-processing pathways become over-responsive, so ordinary touch is read as painful across a broad area. It builds through an attack and settles afterward.
Occipital neuralgia is a peripheral nerve problem. A specific nerve is irritated, so the pain follows that nerve’s territory and has a shooting quality that generalized tenderness does not.
The examination finding differs too. Occipital neuralgia typically has a reproducible tender point where the nerve emerges near the base of the skull, and pressing it can trigger the shooting pain.
Both can occur in the same person, which is part of why untangling them needs an examination. Our note on why migraine pain is often one-sided covers the other side of that comparison.
What Irritates the Nerve
NIH StatPearls describes occipital neuralgia as arising from compression or irritation of the occipital nerves, with several recognized contributors and frequently no single identifiable cause.
Tight muscles at the base of the skull are among the commonly cited mechanisms, since the nerves pass through that muscular layer on their way up.
Trauma to the back of the head or neck features as well, including whiplash and injuries that seemed minor at the time.
Changes in the upper cervical spine can contribute, and so can sustained positions that load the base of the skull for long periods.
In a substantial share of cases the cause is not established, and treatment proceeds on the symptoms rather than on a found lesion. Our guide to posture and migraine covers the positional contribution.
How It Is Assessed and Managed
- Describe the character precisely. Shooting and electric are diagnostically different from aching and throbbing.
- Point to where it starts and where it travels. The path is the most useful thing you can convey.
- Mention the tender spot if you have found one. Reproducibility by pressure is a recognized sign.
- Report any head or neck injury. However long ago and however minor it seemed.
- Expect a physical examination rather than a scan first. Imaging is used to exclude other causes.
- Ask about a diagnostic nerve block. The American Association of Neurological Surgeons describes occipital nerve blocks as both diagnostic and therapeutic for this condition.
- Treat conservative measures as the starting point. Heat, massage and physical therapy commonly come before anything invasive.
Our roundups of neck wraps and heating pads cover the comfort measures, and our roundup of occipital nerve stimulation covers the device category used in refractory cases under specialist care.
Our guide to how migraines are diagnosed covers the wider sorting process, since establishing that this is not migraine is part of the work.
Recommended Reading
Frequently Asked Questions
What is occipital neuralgia?
Nerve pain in the territory of the occipital nerves, which run from the upper neck up the back of the scalp. The characteristic pain is sharp, shooting or electric, arriving in bursts, often with a duller ache between them and a tender point at the base of the skull.
How is it different from a migraine?
The pain character and distribution differ. Occipital neuralgia produces shooting bursts along a nerve path, while migraine produces a building, often throbbing pain with nausea and light sensitivity. Occipital pain can also be reproduced by pressing a specific spot at the base of the skull.
Is this the same as the tender scalp I get with migraines?
No. Migraine scalp tenderness is allodynia, a central sensitization effect where ordinary touch is read as painful across a broad area during an attack. Occipital neuralgia is irritation of a specific peripheral nerve, producing shooting pain along that nerve’s path rather than diffuse soreness.
Why does it hurt behind my eye?
Referral of occipital pain to the area behind the eye on the same side is a recognized feature of the condition. It happens because of how sensory pathways from the upper neck and the head converge, and it is one of the main reasons migraine is suspected before this is.
What causes the nerves to become irritated?
Commonly cited contributors include tight muscles at the base of the skull, trauma to the head or neck including whiplash, changes in the upper cervical spine, and prolonged sustained positions. In a substantial share of cases no single cause is identified and treatment addresses the symptoms.
How is it diagnosed?
Clinically, through the pain’s character and distribution plus physical examination, including checking whether pressure over the nerve reproduces the pain. Imaging is used to exclude other causes rather than to confirm this one. A nerve block that relieves the pain supports the diagnosis.
What treatments are used?
Conservative measures generally come first, including heat, massage and physical therapy directed at the muscles the nerves pass through. Occipital nerve blocks are used both to confirm and to treat. Medications for nerve pain and, in refractory cases under specialist care, nerve stimulation are further options.
When should I see a professional?
See a clinician for any persistent pain at the back of the head, since several conditions present there. Seek urgent care for a sudden severe headache, pain with fever and a stiff neck, pain following a significant head injury, or any new weakness, numbness, vision change or speech difficulty.
Sources
- National Institute of Neurological Disorders and Stroke. Occipital neuralgia.
- National Institutes of Health, StatPearls. Occipital neuralgia.
- American Association of Neurological Surgeons. Occipital neuralgia and occipital nerve blocks.
