Why do people get occipital headaches and how to treat it?

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A common type of headache is experienced in the back of the head, often shooting up the scalp and perceived as “back of the eye”. It is important to recognize because there are targeted pain interventional treatments that can be very effective.

Occipital headache

Occipital headache is headache experienced on the back of the head, sometimes up the scalp, around the ear, & felt as behind the eye (“retroorbital pain”). It can be mistaken as a migraine, or be a trigger for migraine attacks.

3 common sources of occipital headache

There are 3 nerves in the area that can be painful:

  1. Lesser occipital nerve: pain goes around the ear, commonly impinged on by eyeglass frames
  2. Greater occipital nerve: most commonly involved. It passes through several muscles it controls, setting up for several impingement sites.
  3. Third occipital nerve: pain more towards the center line of the head, often seen in traumatic injuries


  • Physical examination
  • Diagnostic nerve blocks under ultrasound (greater & lesser occipital nerves), or under fluoroscopy (third occipital nerve)
  • Rule out cervical facet arthropathy


  • Repeated nerve blocks with local anesthetics can help reduce central sensitization and neurogenic inflammation
  • Nerve blocks with steroids can help reduce tissue inflammation
  • Botox injection into the neck muscles can reduce muscle tension so as to reduce nerve impingement. Botox can also directly reduce neurogenic inflammation.
  • Radiofrequency ablation of the nerve can provide substantial relief lasting months
  • Surgical decompression or resection of the nerve
  • Comprehensive pain management including pain psychology, physical therapy, and complementary & alternative medicine (CAM)