You’re experiencing intense head pain, but you’re not sure if it’s a headache, migraine, or a lesser-known condition called occipital neuralgia. What are the most common occipital neuralgia symptoms that can lead to a correct diagnosis? We discuss 12 of the leading symptoms, and also talk about how this condition differs from migraines and headaches.

What causes occipital neuralgia? 

Its symptoms are similar to headache, but occipital neuralgia has a distinct origin that is often quite different than typical headaches and migraines. Occipital neuralgia is caused by irritation, inflammation, or injury to the occipital nerves. The occipital nerves run up from the base of the neck to the back of the skull, as shown below.

Occipital Neuralgia Symptoms |

John Hopkins Medicine explains how these enervate the head:

“Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. There is one nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. They sometimes reach nearly as far forward as the forehead, but do not cover the face or the area near the ears; other nerves supply these regions.”

Occipital neuralgia occurs when these nerves are damaged. Most often, an isolated incident is to blame. Considerable trauma or injury to the head or neck can damage these nerves. This often occurs in a car accident or some other injury that causes whiplash.

Other common causes include overly tight neck muscles, arthritis, and diabetes. You can learn more about each of these in our post “8 Of The Most Common Causes Of Occipital Neuralgia.”

Since there are very specific occipital neuralgia causes, this condition is often confused with migraines or other severe headaches. True occipital neuralgia is rare. The American Migraine Foundation estimates that only 3.2 people out of 100,000 actually suffer from this condition. The following video talks about occipital neuralgia symptoms and causes in more detail.

What are the most common occipital neuralgia symptoms? 

To determine if you’re suffering from occipital neuralgia vs migraine or other types of headaches, it’s important to look at the symptoms of occipital neuralgia.

The most common occipital neuralgia symptoms include:

  1. Sudden, severe, and sharp head pain
  2. Pain that occurs most commonly behind the eye, at the base of the head, and on one side of the head
  3. Sensitivity to light
  4. Scalp tenderness
  5. Blurry vision
  6. Dizziness
  7. Vertigo
  8. Slurred speech
  9. Nausea
  10. Vomiting
  11. Tightness and pain in the neck
  12. Dental pain

Let’s talk about these occipital neuralgia symptoms in more detail.


Pain is the most characteristic symptom of occipital neuralgia, and often the most debilitating for patients. But pain, in and of itself, is a broad term. Occipital neuralgia pain in particular is often described as:

  • Episodic
  • Shocking
  • Shooting
  • Radiating
  • Aching
  • Burning
  • Throbbing
  • Intense
  • Piercing
  • Stabbing
  • Sharp
  • Spasms

While migraine sufferers may deal with dull and aching pain that doesn’t go away, occipital neuralgia produces a much more intense and (typically) shorter period of pain. Most commonly, this pain is felt most commonly:

  • Along the occipital nerves
  • At the base of the head, where the neck meets the skull
  • On the back of the head
  • Oftentimes on one side of the head, though it can also be bilateral (or both sides)
  • Behind one eye

All patients will experience this pain differently, however. Some do experience more throbbing, dull pain, while others feel pain and tenderness on the sides of the head or even forehead. Many patients may only feel pain for a few seconds, or a few minutes.


Sensitivity, in multiple forms, is another one of the most characteristic occipital neuralgia symptoms.

If you’re suffering from occipital neuralgia, you’ll typically feel severe tenderness directly over the affected occipital nerves. When these areas are touched or compressed, pain will flare up. This sensitivity might only last for a few seconds, but nerves often stay tender afterwards. One of the main ways doctors diagnose this condition is by palpating these areas, since it can help them determine if occipital neuralgia or migraines are leading to your pain.

As the American Association of Neurological Surgeons explains, this tenderness can directly impact multiple facets of your life. They note that: “The scalp may be tender to the touch, and an activity like brushing the hair may increase a person’s pain.” Other activities that cause pain include laying down on a pillow, turning the head to the side, or moving the neck.

Beyond touch sensitivity, many with this condition also experience light sensitivity.

12 Of The Most Common Occipital Neuralgia Symptoms |

Balance and coordination issues

Like migraine, occipital neuralgia symptoms also include those that affect balance and coordination.

These include:

  • Vision issues, such as blurry eyes
  • Vertigo
  • Dizziness
  • Nausea (and vomiting in severe cases)
  • Slurred speech

Referred pain 

Finally, the human body is a complex organism. Pain, especially severe pain, in one area can affect and lead to pain in other areas.

Those with occipital neuralgia often experience increased neck pain, especially when moving the head. They may also feel tightness, stiffness, or spasms in the neck.

Likewise, they may also experience dental pain or pain around the mouth and jaw.

How can I tell the difference between a headache or migraine vs. occipital neuralgia? 

Occipital neuralgia is a rare condition, but when it does occur, it’s most often misdiagnosed at first. Conditions that share many of the same symptoms include:

There are a few tells that can help you determine if you’re suffering from occipital neuralgia or another headache disorder, most notably migraines. However, do note that these differences can only be used in a general manner. Everyone will experience pain differently, so it’s always best to talk to a certified pain specialist to get a correct diagnosis. Misdiagnosing the cause of your pain can lead to ineffective treatments and sustained pain.

The major differences between migraines vs occipital neuralgia include:

  • Type of pain: Migraine pain is most often dull, throbbing, and occurs over a few hours; occipital neuralgia pain is typically episodic, sharp, and intense for short bursts of time
  • Location of pain: Occipital neuralgia sufferers will experience pain upon palpation of the occipital nerves; this may or may not occur for migraine patients
  • Vision symptoms: Both cause vision issues, but eye watering and redness is more characteristic of other headaches, while occipital neuralgia tends to produce blurry vision or pain behind the eyes
  • Pain triggers: Migraines, in particular, often have known triggers, like light, certain smells or foods, or stress; occipital neuralgia most often occurs when turning or moving the head

To determine if you’re suffering from one condition or the other, start by keeping a pain diary today. This is an invaluable tool that helps you clearly explain to your doctor the symptoms you’re experiencing. We talk about some of the best options in “29 Of The Best Chronic Pain Apps.”

How do you treat occipital neuralgia? 

Treatment starts with diagnosis, continues with preventative efforts, and includes both interventional and complementary therapies to treat pain.

Your doctor can determine if you have this condition by:

  • Reviewing the notes and potential triggers you noted in your pain diary
  • Conducting a thorough physical exam, including palpation of the occipital nerve area
  • Ordering other diagnostic tests as needed, such as MRIs, CT scans, X-rays, or blood tests
  • Performing a diagnostic occipital nerve block (that can also be used therapeutically, as the following video discusses)

Once you’ve realized that you have occipital neuralgia, there are proven treatments that can help. Occipital neuralgia is a debilitating and painful condition, but it isn’t life-threatening. Through a combination of therapies you can manage and prevent most of the pain associated with this condition. As Medical News Today explains: “The aim is to provide many people with relief by relaxing and releasing the muscles that are putting pressure on the occipital nerves.”

We talk about all of your treatment options (at-home, complementary, medications, and interventional) in “How To Treat Occipital Neuralgia: 21 Of The Best Methods.” Visit that post for an in-depth discussion of treatments and therapy approaches.

If you think you’re suffering from occipital neuralgia symptoms, it’s time to talk to a pain specialist. Because this is a more complex and rare condition, they’re equipped to lead diagnosis efforts and present different treatment approaches. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here.

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