Maybe you “slept wrong” and your neck hurts. But sometimes, pain at the base of the skull means something more serious. A neurologist explores occipital neuralgia.

Published: March 22, 2023 | Updated: September 14, 2023

Pain in the upper neck, back of the head and behind the ear can be a symptom of occipital neuralgia. True occipital neuralgia is rare, affecting an estimated 3.2 per 100,000 people per year. The symptoms of occipital neuralgia can impact a patient’s quality of life, depending on severity.

Symptoms include:

• Shooting, stabbing or throbbing pain at the base of the skull
• Pain that starts at the upper neck and spreads along the scalp on one or both sides of the head

Burning, throbbing or aching pain on the scalp, or the scalp becoming extremely sensitive to the touch (allodynia)

READ MORE: What to do if you have a painless lump on the side of your neck

Pain or uncomfortable sensations may be felt in the upper neck, back of the head, behind the eyes and ears (typically on one side of the head), scalp, or forehead.

Occipital neuralgia is caused by irritation of the occipital nerves, which may be a result of trauma (for example, whiplash) or inflammation, or it may be idiopathic.

Diagnosing and referring for occipital neuralgia

“With occipital neuralgia, it can be tricky to pinpoint the cause as it is often times multifactorial,” said Brian M. Plato, D.O., neurologist and headache medicine specialist with Norton Neuroscience Institute. “Often times, patients will have many overlapping migraine symptoms including light and sound sensitivity and nausea.”

There is no one test for occipital neuralgia. A physical exam and neurological exam are important, as is a thorough medical history.

There is no specific treatment for occipital neuralgia, and no treatments are specifically FDA approved for the condition. Treatments such as muscle relaxants or tricyclic antidepressants are the first line treatment. Occipital nerve blocks can also at times be effective although the duration of benefit varies significantly from patient to patient.

If nonsurgical interventions do not provide enough relief, surgical interventions may be considered; although these procedures can be more challenging to have consistently covered by insurances.

Read more: Pain in the front of your neck: When to worry