Pain in the Back of Your Head: What It Means

When headache pain is on the back of your head, it's often due to a primary headache disorder called a tension-type headache. This type of headache is very common and not a cause for alarm.

While it's less common, secondary headaches (those that are caused by another health condition) are sometimes behind headache pain in the back of the head. Sometimes, this type of pain may be related to a serious issue.

This article reviews possible primary and secondary causes of headaches on the back of the head, how these headaches are treated, and when you should see a healthcare provider.

Pain All Over the Back of the Head

Headache pain all over the back of the head is most commonly a tension-type headache. While nagging and unpleasant, tension-type headaches are not worrisome, and most can be relieved fairly quickly.

Less often, headache pain on the back of your head can indicate a more serious secondary headache, such as a low-pressure headache.

Tension-Type Headache

Tension-type headaches are the most common type of headache and, therefore, the most likely source of a "back of the head" headache.

These headaches cause a gripping, tightening, or pressure-like sensation around the head and neck. Imagine wearing a tight headband or a baseball hat that is too small. The headache pain is mild-to-moderate in intensity and doesn't worsen with physical activity.

Experts aren't completely sure why tension-type headaches develop. It's likely that multiple factors are involved, such as sensitization of pain pathways in the nervous system and/or environmental triggers like stress, lack of sleep, or skipping meals.

Symptoms that may accompany a tension-type headache include:

• Light or sound sensitivity (not both)
• Reduced appetite
• Shoulder and upper back stiffness
• Trouble concentrating
  

Low-Pressure Headache

A low-pressure headache, also known as spontaneous intracranial hypotension, develops as a result of low cerebrospinal fluid pressure in the brain. Cerebrospinal fluid (CSF) is a clear fluid that flows through and cushions the brain and spinal cord.

If spinal fluid leaks because of a tear in the dura (one of the membranes that cover the spinal cord), pressure around the brain is lowered. This causes a severe headache, typically felt at the back of the head.

A low-pressure headache is felt when sitting or standing up and is relieved within 20 to 30 minutes of lying flat. It's usually also worsened when coughing, sneezing, or exercising.

Symptoms that may accompany a low-pressure headache include:

• Neck stiffness
• Tinnitus (ringing in the ears)
• Dizziness
• Double vision or blurry vision
  

Back Right or Left Side of the Head

Sometimes headaches are felt at the back of the head, but only on one side. Cervicogenic headache and occipital neuralgia are secondary headaches that present in such a manner.

Cervicogenic Headache

Cervicogenic headaches are believed to be caused by a bone, joint, nerve, or a soft tissue problem in the upper spine, such as arthritis, a pinched nerve, or neck muscle spasm or injury.

Cervicogenic headaches manifest as one-sided headaches that begin in the neck and spread from the back of the head to the front. The pain is usually moderate-to-severe in intensity, non-throbbing, and worsens with certain head or neck movements.

Cervicogenic headaches may be accompanied by neck stiffness and arm or shoulder pain on the same side of the headache.

Occipital Neuralgia

Occipital neuralgia is pain in the areas of skin supplied by the greater occipital or lesser occipital nerves. These nerves originate in the neck and travel up to each side of the head to the scalp.

The pain of occipital neuralgia is believed to arise from occipital nerve entrapment or irritation by a tight muscle, blood vessel, or trauma during a whiplash injury.

The headache associated with occipital neuralgia is typically one-sided, severe, sudden in onset, and stabbing or shooting in nature. It classically begins in the neck and spreads from the back to the top of the head.

Symptoms associated with occipital neuralgia include:

• Vision changes and/or eye pain
• Tinnitus
• Stuffy nose
• Decreased or abnormal sensations along the nerve

Treatment

Once your headache type is diagnosed, you can move forward with a treatment plan.

Tension-Type Headache

Tension-type headaches are usually alleviated with an over-the-counter pain reliever like Tylenol (acetaminophen) or the nonsteroidal anti-inflammatory drug (NSAID) Advil (ibuprofen).

Be sure to talk to your doctor before taking any medication. In addition to ensuring it's safe, you want to avoid complications like medication overuse headaches. These headaches occur when your body becomes accustomed to painkillers.

Low-Pressure Headache

Conservative therapies like bed rest, caffeine, and hydration are usually implemented first to manage a low-pressure headache. Headaches tend to resolve within a few days to two weeks.

If the headache is severe or persists, a procedure to place an epidural blood patch may be performed. During this procedure, your own blood is removed from your arm and injected into the epidural space (located just outside the dura) in the lower spine. Relief is usually immediate.

Cervicogenic Headache

Physical therapy tends to be part of the initial treatment plan for cervicogenic headache. A physical therapist can combine cervical neck manipulation and mobilization along with neck muscle strengthening exercises.

Maintaining good posture, massage, and ice/heat therapy are also usually recommended. In some cases, patients may be prescribed a nerve pain medication called Lyrica (pregabalin).

For severe or persistent headaches, a pain specialist may perform an anesthetic (numbing) blockade or a corticosteroid injection into the neck.

Occipital Neuralgia

There are multiple treatment options for occipital neuralgia, depending on the severity of the condition.

Common treatments include:

• Medications like Neurontin (gabapentin), Lyrica, or a tricyclic antidepressant
• Physical therapy that incorporates ice/heat therapy, massage, and neck strengthening and stretching exercises
• Nerve block of the greater or lesser occipital nerve

For more severe or persistent cases, botox injections or a minimally invasive procedure that delivers bursts of radiofrequency to the occipital nerve (called pulsed radiofrequency) may be tried.

Surgical release of the occipital nerve tends to be a last resort option.

When to See a Healthcare Provider

Most headaches are not dangerous. There are instances, however, in which your headache warrants a visit or call to your healthcare provider.

These scenarios include:

• Your headaches are becoming more frequent, severe, or interfering with your daily routine.
• You have a new headache and are over age 50, are pregnant or just gave birth, or have a history of cancer or a weakened immune system (e.g., HIV/AIDS).
• Your headache is triggered by sneezing, coughing, or exercising.
  
• You are experiencing a headache associated with taking pain medication regularly.

Summary

Headaches felt at the back of the head are usually tension-type headaches. A "back of the head" headache may also stem from an underlying health condition like arthritis or an irritated nerve in your neck or scalp.

Once your headache type is diagnosed, treatment is usually fairly simple. It may involve medications, physical therapy, or certain procedures.