This is a chronic headache disorder that involves pain originating from the back of the head. It involves the occipital nerves—a pair that originates near the second and third vertebrae of the neck. The pain typically starts at the base of the skull by the nape of the neck and may spread to the area behind the eyes and to the back, front, and side of the head. Occipital headaches are most commonly caused by pinched nerves in the root of the neck. Pain secondary to trauma, such as whiplash injuries, inflammation, and compression of the occipital nerves by arteries or tumors, may also play a role. Conditions that can contribute to occipital headache are osteoarthritis, tumors affecting nerve roots, blood vessel inflammation, gout, diabetes, and infection.
These headaches can have instant onset just from touching the area, like brushing the hair, wearing a hat, or lying on a pillow. During an attack, abnormal and unpleasant sensations on the scalp may occur, and a dull ache may persist between attacks, which are episodic and can last a few seconds to minutes. The pain is described as piercing, stabbing, or sharp in quality and severe in intensity. The pain is felt most often on one side of the head, but may affect both sides. Neck movements may trigger pain in some patients, and the scalp may be tender to the touch.
The doctor will conduct a physical exam, and pain that is associated with pressing on the occipital area will help in diagnosing the type of headache. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may also be beneficial.
Treatment may consist of anti-inflammatory and anti-epileptic drugs, muscle relaxers, and antidepressants. An occipital nerve block can be injected to the affected area to ease the pain. Occipital nerve stimulation, which delivers electrical impulses to block pain, may also be recommended.