Pain in the Back of Your Head: What It Means

A headache is one of the most common sources of discomfort or pain and something that most people will experience at some point in their life.

Headache pain localized to the back of the head is 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.

In some instances, secondary headaches—which arise from an underlying health condition and are more variable in their seriousness—are the culprits behind headache pain in the back of the head.

This article reviews possible primary and secondary causes of headaches located at the back of the head. It also breaks down how these headaches are treated and when you should see a healthcare provider.

Man with headache pain in the back of his head

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Pain All Over the Back of the Head

Headache pain felt 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 eased fairly quickly.

Less commonly, headache pain generalized to 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 for 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 spinal 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.

How Does a Dural Tear Occur?

A tear in the dura may occur after a spinal tap (a medical procedure to sample CSF) or following spinal or epidural anesthesia.

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:

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
Summary: "Back of the Head" Headaches
Pain All Over Pain on One Side
Tension-type headache Cervicogenic headache
Low-pressure headache Occipital neuralgia
Please note this chart does not list all possible causes of headache pain in the back.

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, the patient's own blood is removed from their arm and injected into the epidural space (located just outside the dura) in the lower spine. Patients usually experience immediate relief.

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:

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.

Seek Emergency Care

Go to your emergency room or call 911 if your headache:

  • Is severe, begins abruptly, and/or is the "worst headache of your life."
  • Is severe and accompanied by a painful red eye, high fever, stiff neck, or confusion.
  • Is associated with symptoms of a possible stroke (e.g., weakness, numbness, or vision changes).
  • Occurs after a blow or injury to your head.


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.

A Word From Verywell

While most headaches do not indicate a serious illness, getting to the root cause, in some cases, can be tricky and time-intensive. Even tension-type headaches can mimic several types of secondary headaches.

To ensure a proper diagnosis, consider seeing a healthcare provider who specializes in headache care. This is especially true if your headaches are standing in your way of living a productive and fulfilling life.

Frequently Asked Questions

  • How long does a headache last?

    Different types of headaches can last for varying amounts of time, depending on their severity and whether or not they are treated. For instance, tension-type headaches can last anywhere from 30 minutes to seven days.

  • What can you take for a headache when you’re pregnant?

    If possible, it's best to resort to non-medication options for treating a headache during pregnancy. You might try taking a nap in a dark, quiet room or applying a cool compress to your head.

    Reach out to your healthcare provider if your headache is new, persistent, worsening, or severe. In some instances, your doctor may give you the OK to take Tylenol (acetaminophen).

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