Occipital neuralgia is a relatively rare condition that can cause intense head pain, especially at the base of the skull. Sufferers may also experience pain behind one eye, blurry vision, or light sensitivity. While occipital neuralgia causes aren’t well-understood, there are some known sources that can lead to this condition. These are 8 of the most common, along with information on diagnosing and treating this condition.

What causes occipital neuralgia? 

Occipital neuralgia is also called an occipital headache or occipital neuritis, but all of these names point to a pain condition that originates in the occipital nerves.

At the most basic level, occipital neuralgia is caused by irritation, inflammation, or injury to the occipital nerves. These nerves run from the neck, up through the back of the skull (shown in yellow below). Most often, it’s related to a pinched nerve root in the neck, severely tight neck muscles, or a prior injury.

The Most Common Occipital Neuralgia Causes | PainDoctor.com

The most common occipital neuralgia causes

While irritation, inflammation, and injury are the direct cause of this condition, this doesn’t explain exactly how it occurs. Specific conditions or injuries are more likely to lead to this condition. That being said, occipital neuralgia causes are still not well-understood and no clear consensus has been reached on a direct cause. Oftentimes, patients have symptoms with no known related conditions or past history of injury or trauma.

However, some common occipital neuralgia causes have been hypothesized, including:

  1. Injury to the head and neck
  2. Whiplash
  3. Overly tight neck muscles
  4. Arthritis
  5. Gout
  6. Diabetes
  7. Blood vessel inflammation
  8. Tumors and infections

Let’s take a look at each of these in more detail.

1. Injury

One of the most common causes of occipital neuralgia is injury or severe trauma to the back of the head. If you’re undergoing diagnosis, your doctor will specifically ask about any known trauma or injuries that could have led to your pain. This can occur during a fall, car accident, sport injury, or other event.

An injury can pinch or irritate the nerves in the back of the neck, leading to this specific type of pain. Always talk to your doctor after experiencing any head or neck trauma.

2. Whiplash

Related to injury is whiplash. This is a severe form of trauma where the neck is thrown backwards and forwards far beyond its normal range of motion. Whiplash can occur during rear-end collisions or other high-force events. This extreme motion can lead to excessively tight muscles, irritation to the nerves, or inflammation.

Other symptoms of whiplash may include shoulder pain and stiffness, memory loss, ringing in the ears, and dizziness. Talk to a doctor immediately if you believe you’ve suffered from whiplash.

3. Overly tight neck muscles 

Occipital neuralgia is caused by irritation or inflammation of the occipital nerves that run up through the neck, specifically through the second and third vertebrae. Overly tight or strained muscles in these areas can directly lead to entrapment and compression of the nerves.

You may suffer from overly tight neck muscles if you work in an environment where you keep your head constantly in a downwards or forward position. Many office workers struggle with this, from excessive leaning forwards toward their computer screens. Others may experience in this repetitive, manual-type jobs.

Complementary treatments can help reduce this strain and, thereby, reduce your occipital pain. These include:

  • Setting up an ergonomic office setup
  • Undergoing physical therapy or chiropractic care
  • Practicing stress-reduction strategies, like massage, stretching, and meditation

4. Arthritis 

Arthritis, including osteoarthritis in the cervical spine, is one of the more common causes of occipital neuralgia.

As in joints throughout the rest of our body, the discs in our spine slowly degenerate with age. This can cause the discs of the cervical spine to break down, lose fluid, and become stiffer over time. It can also increase pressure or strain on the occipital nerves, leading to pain. If your pain is related to arthritis, your doctor will combine a number of different therapeutic treatments (discussed below) to minimize your symptoms.

5. Gout 

Gout is also a form of arthritis where too much uric acid in the blood leads to sharp crystals forming within the joints. It most commonly affects the joints in the feet and hands, but in rare cases can affect the cervical spine.

Gout is more common in men, especially those who:

  • Are overweight
  • Are over 40 years old
  • Have high blood pressure, high cholesterol, diabetes, or heart disease

6. Diabetes

Similarly, there is a link between diabetes and occipital neuralgia.

Those who suffer from diabetes are already at an increased risk for headaches due to the ebb and flow of their blood sugar levels. It can also lead to diabetic neuropathy, an inflammation in the nerves themselves. This is most common in the form of diabetic peripheral neuropathy that’s experienced as numbness and pain in the legs. However, it can also lead to occipital neuropathy, or damage in the occipital nerves.

7. Blood vessel inflammation, or vasculitis

There are many different causes of blood vessel inflammation, also known as vasculitis. Most causes are rare. When this inflammation occurs, though, it can lead to thickening, weakening, or narrowing of your blood vessels that can eventually restrict blood flow.

If you believe you’re suffering from blood vessel inflammation, work closely with your doctor to get a diagnosis.

8. Tumors and infections

Less commonly, a tumor in the cervical region can put increased pressure on the occipital nerves. Likewise, a systemic infection in the body can lead to trauma in the occipital nerves.

Both tumors and infections are rare, but they are serious. Talk to your doctor immediately if you’ve detected a lump in your neck or throat, or have trouble swallowing or a persistent sore throat. If you have a fever with a very low body temperature, along with rapid pulse and trouble breathing, you could be suffering from a serious infection. You should also talk to your doctor immediately if you’re experiencing any of these symptoms.

Is occipital neuralgia serious? 

This is not a life-threatening condition, but it can lead to serious and severe symptoms that affect every part of a person’s life. As John Hopkins Medicine explains:

“In some patients the scalp becomes extremely sensitive to even the lightest touch, making washing the hair or lying on a pillow nearly impossible. In other patients there may be numbness in the affected area. The region where the nerves enter the scalp may be extremely tender.”

So, while occipital neuralgia may not be life-threatening, it’s certainly a condition that should be managed in coordination with your healthcare team. While there is no single cure for this condition, there are multiple treatment options ranging from at-home prevention and care to interventional approaches. The following video gives an overview of this condition, along with treatment options.

Do I have occipital neuralgia? 

This is a rare pain condition, so oftentimes the answer is no. The American Migraine Foundation estimates that only 3.2 out of 100,000 people actually suffer from this condition. More often, similar symptoms are related to migraines or other forms of headache.

Migraines, in particular, can repeatedly be felt in the back of head and on one particular side where they inflame the greater occipital nerve. This is referred to as “migraines involving the greater occipital nerve” rather than occipital neuralgia itself, and requires different forms of treatment.

Diagnosing occipital neuralgia 

To determine if you’re suffering from occipital neuralgia, your doctor will first run through a series of exams. Talk frankly and honestly about any and all symptoms you’ve been experiencing. From there, your doctor will also perform a physical exam. Chiefly, they’ll press firmly at the back of your head where the occipital nerves sit. If they can reproduce your pain, it could help point to a diagnosis.

They can also order diagnostic tests, including MRI scans, CT scans, X-rays, or blood tests to determine your occipital neuralgia causes.

Finally, if they believe you’re suffering from occipital neuralgia, they’ll perform a diagnostic occipital nerve block.