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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A doctor can recognise occipital neuralgia by video and start treatment; the nerve block that confirms it, injections and surgery are in person.
- What it is: irritation or inflammation of the occipital nerves, which run from the top of the spine up through the scalp, causing sharp, shooting pain at the back of the head.
- How long attacks last: from a few seconds to a few minutes, sometimes 20 or 30 attacks a day in a bad spell, and many people have a constant ache or burning between the attacks.
- How common: true isolated occipital neuralgia is quite rare: many headaches at the back of the head turn out to be migraine or tension headaches.
- Emergency: call 112 for a sudden, severe headache, a headache with a high temperature and a stiff neck, new weakness, numbness or vision loss, or a headache after a head injury.
Do not book a video appointment for a headache at the back of the head that came on suddenly and is extremely painful, a headache with a high temperature, a stiff neck or a rash that does not fade when a glass is rolled over it, a headache with weakness, numbness, slurred speech, loss of vision, drowsiness, confusion or a seizure, or a headache after a head injury. Call 112 or go to an emergency department.
Can an online doctor treat occipital neuralgia?
Partly. There is no single test for occipital neuralgia: it is recognised from how the pain behaves, which a doctor can go through by video, together with the other causes of pain at the back of the head. The doctor can advise on self-care and physiotherapy and prescribe treatment when it helps. A nerve block, which confirms the diagnosis and eases the pain for a while, injections, scans and surgery are done in person.
How an online consultation helps with occipital neuralgia
- Nerve pain or another headache?: Migraine and tension headaches often hurt at the back of the head too, and they are treated differently.
- Warning signs checked first: A sudden, severe headache, fever with a stiff neck, or new weakness or numbness needs 112.
- A plan that starts at home: Heat, posture, neck exercises and physiotherapy, with medicine when it helps.
- The right referral: When a nerve block, a scan or a specialist is the next step, and what to ask for.
What the doctor checks in an online occipital neuralgia consultation
The doctor asks about the warning signs first, then about the pain itself. The doctor asks about:
- Warning signs: a sudden, severe start, a high temperature, a stiff neck, weakness, numbness, vision changes, confusion, or a recent head or neck injury.
- The pain: where it starts and spreads, whether it shoots or aches, how long attacks last, and whether one or both sides hurt.
- Your scalp: soreness when you brush your hair or lie on a pillow, numbness, and tender spots at the base of the skull.
- Migraine features: feeling sick, sensitivity to light or noise, or an aura, which point to migraine instead.
- Your neck: stiffness, arthritis, an old whiplash injury, desk work and posture.
- Your health: diabetes, gout, earlier surgery to the head or neck, pregnancy and your medicines.
Before the call, note where the pain starts, what sets it off and how long it lasts. During the call, the doctor may ask you to press gently at the base of your skull to find tender spots.
What is occipital neuralgia?
Occipital neuralgia is a headache disorder in which the occipital nerves become irritated, injured or inflamed. The greater occipital nerves, one on each side, and the smaller lesser and third occipital nerves carry feeling from the upper neck over the back and top of the scalp. The pain is similar to trigeminal neuralgia, but on the scalp rather than the face.
What does occipital neuralgia feel like?
- sharp, shooting, stabbing or electric-shock pain, starting at the base of the skull and spreading up over the scalp
- attacks lasting from a few seconds to a few minutes, on one or both sides
- a continuous aching, burning or throbbing between the attacks
- pain behind the eye on the same side
- a scalp so sensitive that brushing your hair or lying on a pillow hurts
- tenderness at the base of the skull, and sometimes numbness over the back of the head
Is occipital neuralgia worse when lying down?
It can be. The scalp can be so sensitive that lying with the back of your head on a pillow sets off the pain. A low, firm pillow that keeps your head level with your body can help.
What causes occipital neuralgia?
Many cases come from tight neck muscles or long-standing neck tension, and some have no clear cause. Known causes include:
- a pinched nerve or tight muscles at the back of the head or neck
- a head or neck injury, including whiplash, or earlier surgery to the scalp or skull
- arthritis or wear in the upper spine, and disc disease in the neck
- diabetes, gout and inflammation of the blood vessels
- rarely, an infection or a growth pressing on the upper neck nerves
Headache at the back of the head: what can it mean?
Most headaches at the back of the head are tension headaches or migraine. True isolated occipital neuralgia is quite rare, and migraines can irritate the occipital nerve and feel very similar. These are the main causes and how they differ:
Swipe sideways to compare →
| Cause | How it feels | Other clues | What to do |
|---|---|---|---|
| Occipital neuralgia | Shooting or electric attacks of seconds to minutes, from the base of the skull upwards | A sore scalp, tender spots at the base of the skull | See a doctor; a nerve block in person if needed |
| Tension headache | A dull, tight band on both sides of the head | You can carry on, no sickness | Self-care; see a doctor if they are frequent |
| Migraine | Throbbing, moderate to severe, for 4 to 72 hours | Feeling sick, light and noise sensitivity, worse with activity | See a doctor for treatment |
| Neck pain spreading to the head | Aching that starts in the neck | Stiffness, often after poor posture or sleeping awkwardly | Self-care; see a doctor if it lasts more than a few weeks |
| A headache set off by coughing, sneezing, bending or exercise | Varies | Needs checking for another cause | Get medical advice urgently |
| A thunderclap headache | Sudden and extremely painful, at its worst within 5 minutes | Needs emergency checks | Call 112 |
Pain that starts in the neck joints or in tight neck muscles can spread to the back of the head and look like occipital neuralgia, so the doctor asks about your neck too.
How is occipital neuralgia diagnosed?
No single test confirms or rules it out. Doctors diagnose it when the pain is in the area of an occipital nerve and has the typical features:
- attacks that are severe, shooting or stabbing, and last seconds to minutes
- pain or odd feelings set off by lightly touching the scalp or hair
- tenderness over the nerve, or trigger points at the base of the skull
- pain that eases for a while after a local anaesthetic is injected around the nerve, called an occipital nerve block
The nerve block is done in person, and it both confirms the diagnosis and treats the pain. An MRI or CT scan may be used to rule out other causes, such as a pinched nerve in the neck.
Which occipital neuralgia treatment might the doctor recommend?
Treatment aims to relieve the pain, starting with simple measures. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Shooting pain at the back of the head with a sore scalp | Heat, massage, posture changes and an anti-inflammatory painkiller | Yes | For a nerve block if it does not settle |
| Pain with neck stiffness after desk work or poor sleep | Neck exercises, a low, firm pillow and physiotherapy | Yes | If pins and needles or weakness in the arm appear |
| Pain that keeps coming back despite self-care | A preventive nerve-pain medicine, or a referral for a nerve block | Partly | For the nerve block, given in person |
| Back-of-head pain with migraine features | Migraine treatment | Yes | If the pattern changes |
| Severe pain that does not respond to blocks or medicines | A specialist for injections or surgery | Partly | A pain specialist or neurosurgeon |
| A sudden, severe headache, fever with a stiff neck, or new weakness or numbness | Emergency care | No | Call 112 now |
Shooting pain at the back of your head? A doctor can tell you in one consultation whether it is nerve pain, migraine or something else.
See available times →Treatment options for occipital neuralgia
Treatment relieves the pain but is not always a cure. Most people improve, and many get better with simple measures.
What you can do yourself
- Use heat on the back of the neck, such as a hot water bottle wrapped in a tea towel, or a cold pack if that suits you better.
- Massage the tight muscles at the back of the neck, or ask a physiotherapist about massage and exercises.
- Sit upright, roll your shoulders back, and do not hold one position for long, especially at a desk.
- Use a low, firm pillow, keep your head level with your body, and avoid sleeping on your front.
- Keep your neck moving with gentle exercises rather than holding it stiff.
- Take paracetamol or ibuprofen for the pain.
Prescription treatment
A prescription is never issued without a consultation. If simple painkillers are not enough, the doctor may prescribe an anti-inflammatory painkiller, a muscle relaxant, or an anticonvulsant medicine that calms nerve pain. Gabapentin and pregabalin are controlled medicines and are never prescribed online, and codeine and other opioids are never prescribed online either. If the doctor prescribes, use the prescription at a pharmacy near you.
Injections and surgery, in person
Swipe sideways to compare →
| Treatment | What it involves | What to expect |
|---|---|---|
| Occipital nerve block | An injection of local anaesthetic, often with a steroid, around the nerve | Confirms the diagnosis and eases pain; the effect of steroid injections may wear off after 3 to 6 months |
| Botulinum toxin injections | Injections to calm the irritated nerve | Can reduce inflammation of the nerve |
| Radiofrequency treatment | Heat applied to the nerve | Can leave the scalp permanently numb |
| Occipital nerve stimulation | A small device under the skin sends pulses to the nerve | For pain that has not responded to other treatment |
| Nerve release surgery | Frees the nerve from tight tissue | Usually a day procedure, with recovery in 1 to 2 weeks; pain can come back |
What does not help
Holding your neck still or wearing a collar unless a doctor advises it. Painkillers on most days of the month, which can cause medication overuse headache. Opioid painkillers.
Is occipital neuralgia serious, and does it go away?
Occipital neuralgia is not life-threatening. With the right treatment, the pain improves for most people, and it usually goes away once the nerves heal. It can come back, and some people need regular stretching, medicine or repeat injections to keep it under control.
What matters is not missing something else. A headache at the back of the head that came on suddenly and severely, or comes with a high temperature, a stiff neck, double vision, weakness, numbness, problems with speech or sudden confusion, needs emergency care.
Special situations
After a head or neck injury
Occipital neuralgia can follow a whiplash or head injury, but a headache after a head injury needs emergency assessment first. The concussion page covers recovery.
Desk work and screens
Sitting at a desk for long periods is a common cause of neck pain. Sit upright, take regular breaks, and keep your neck moving.
Pregnancy
Tell the doctor if you are pregnant: paracetamol is the usual first choice, and several medicines and injections need extra care.
Occipital neuralgia while travelling in Europe
Long journeys sitting in one position can strain the neck. Take breaks, keep your neck moving, and a warm pack can help. The same warning signs mean 112 wherever you are.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When occipital neuralgia is treated online, and when you need in-person care
Treated online: recognising occipital neuralgia from the pattern of the pain, telling it apart from migraine, tension headache and neck pain, self-care and physiotherapy advice, and non-controlled medicines, with follow-up.
In-person care: nerve blocks, botulinum toxin and other injections, scans, surgery, and any headache with warning signs.
When to get in-person care
Call 112 or go to an emergency department now for:
- a headache that started suddenly and is extremely painful, reaching its worst within 5 minutes (a thunderclap headache)
- a headache with a very high temperature, a stiff neck, sensitivity to light, or a rash that does not fade when a glass is rolled over it
- a headache with new numbness or weakness, slurred speech, double vision or loss of vision
- a headache with drowsiness, sudden confusion or a seizure
- a headache after a head injury
Get medical advice the same day for:
- a headache set off or made worse by coughing, sneezing, bending down or exercise
- a headache with vomiting
- a new headache with jaw pain when eating or a tender scalp at the temples, if you are over 50
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about the pain: say where it starts and spreads, how long attacks last and what sets them off, and mention any neck problems or injuries.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s occipital neuralgia? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Neck pain can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about occipital neuralgia
What is occipital neuralgia?
A headache disorder in which the occipital nerves, which run from the top of the spine over the back of the scalp, become irritated or inflamed. It causes sharp, shooting pain from the base of the skull over the back of the head.
What does occipital neuralgia feel like?
Occipital neuralgia feels like shooting, stabbing or electric-shock pain that starts at the base of the skull and spreads up the scalp, in attacks of seconds to minutes. Many people also have a constant ache, pain behind one eye and a scalp too sore to brush or lie on.
What causes occipital neuralgia?
Occipital neuralgia is often caused by tight neck muscles or a pinched nerve, a head or neck injury such as whiplash, arthritis or wear in the upper spine, or conditions such as diabetes and gout. Sometimes no cause is found.
What does a headache at the back of the head mean?
Most often a tension headache or migraine, sometimes pain spreading from the neck, and less often occipital neuralgia. A sudden, extremely painful headache at the back of the head, or one with a fever and a stiff neck, needs 112.
Is occipital neuralgia worse when lying down?
It can be. With occipital neuralgia the scalp can be so sensitive that lying with the back of your head on a pillow sets off the pain. A low, firm pillow that keeps your head level with your body can help.
How long does occipital neuralgia last?
Each occipital neuralgia attack lasts from a few seconds to a few minutes. The condition itself usually improves with treatment and often goes away once the nerves heal, but it can come back.
Is occipital neuralgia serious?
No, occipital neuralgia is not life-threatening. The important thing is not to miss another cause: a sudden, severe headache, or one with a high temperature, a stiff neck, vision problems, weakness or numbness, needs emergency care.
How do you fix occipital neuralgia at home?
Start with heat, massage, better posture, neck exercises and a painkiller. If the pain continues, a doctor may prescribe a nerve-pain medicine or refer you for an occipital nerve block. Surgery is only for severe pain that does not respond.
How can I prevent occipital neuralgia coming back?
Keep the neck moving and strong with daily gentle stretches and the exercises a physiotherapist sets, break up long spells at a desk or screen and keep the monitor at eye level, use a pillow that keeps the head level with the spine, avoid carrying heavy bags on one shoulder, manage stress and jaw clenching, keep the back of the neck warm in cold wind, and treat arthritis or an old whiplash injury. Occipital neuralgia flares from posture are the most preventable kind.
Is it occipital neuralgia or migraine?
Occipital neuralgia causes short, shooting attacks with a sore scalp. Migraine causes throbbing pain for hours to days, usually with sickness or sensitivity to light and noise. Migraine can also irritate the occipital nerve, so they are easily confused.
What is an occipital nerve block?
An injection of local anaesthetic, often with a steroid, around the occipital nerve at the back of the head. If it eases the pain, it confirms the diagnosis, and the relief can last for weeks or months.
Can occipital neuralgia be cured?
Treatment relieves occipital neuralgia rather than always curing it, but most people improve and many become pain-free once the nerves heal. Some need ongoing stretching, medicine or repeat injections.
Can an online doctor treat occipital neuralgia?
Partly. A doctor can recognise occipital neuralgia by video, rule out other causes of back-of-head pain, and start self-care, physiotherapy advice and medicine. Nerve blocks, other injections, scans and surgery are in person.
- 13.4 Occipital neuralgia, International Classification of Headache Disorders, 3rd edition (ICHD-3), International Headache Society, 2018.
- Occipital neuralgia, Cleveland Clinic (US), reviewed 21 May 2022.
- Occipital neuralgia, Johns Hopkins Medicine (US), accessed 15 October 2026.
- Occipital neuralgia, American Association of Neurological Surgeons (AANS), 30 April 2024.
- Neck pain, NHS, National Health Service (UK), reviewed 27 April 2023.
- Tension headaches, NHS, National Health Service (UK), reviewed 1 August 2025.
- Headaches, NHS, National Health Service (UK), reviewed 17 April 2024.
- Headaches in over 12s: diagnosis and management (CG150), NICE, National Institute for Health and Care Excellence, 2012, updated 2021.
- Could painkillers be causing your headaches?, NICE, National Institute for Health and Care Excellence, 2012.
- Giant cell arteritis: symptoms and causes, Mayo Clinic (US), updated 2 June 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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