Occipital neuralgia is a nerve pain felt at the back of the head, caused by irritation of the occipital nerves that run from the top of the neck up into the scalp. It causes sudden shooting, stabbing or electric-shock pains, usually on one side, and the scalp can feel tender to touch. It is uncommon and is easily confused with migraine or headaches coming from the neck, so a careful assessment matters.
Also known as occipital nerve pain, Arnold's neuralgia
Symptoms
- Sudden shooting, stabbing or electric-shock pain at the back of the head, lasting seconds to minutes
- Pain that starts at the base of the skull and travels up over the scalp, usually on one side
- A tender scalp, so that brushing your hair or resting your head on a pillow is uncomfortable
- Tenderness when pressing where the nerve leaves the top of the neck
- A dull ache or burning feeling between attacks
- Pain that sometimes spreads towards the back of the eye
Causes and risk factors
- Often no clear cause is found
- Tight muscles at the top of the neck pressing on the nerve
- A whiplash injury or a blow to the back of the head
- Arthritis in the upper joints of the neck
- Less commonly, medical conditions such as diabetes, gout or shingles
- Rarely, a growth or other structural problem, which is why new symptoms need a medical opinion
What the evidence says helps
- Diagnosis is based on the pattern of pain and tenderness over the nerve. The international criteria also include temporary relief from a local anaesthetic injection around the nerve.1
- Treatment usually starts with conservative care: heat, rest from aggravating positions, massage and physiotherapy-type treatment, and simple pain relief.2
- If that is not enough, doctors may use nerve-pain medicines such as certain anticonvulsants or antidepressants.2
- A nerve block, an injection of local anaesthetic with or without steroid, eases the pain for weeks or months in many people.2
- Procedures such as pulsed radiofrequency or nerve stimulation are kept for persistent cases. The studies are small, and procedures that destroy the nerve carry real risks.2
Things you can try at home
- Use gentle heat at the back of the neck
- Keep your neck moving gently, and change position often when working at a desk
- Avoid long-lasting pressure on the back of the head from tight hats, headbands or hard headrests
- Ask a pharmacist about suitable pain relief
- Note what sets the pain off, so you can describe the pattern to your GP or practitioner
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden, severe headache that reaches its peak within a minute (thunderclap headache): call 999
- Headache with a fever, stiff neck, a rash, confusion or drowsiness: call 999
- Headache with weakness, numbness, slurred speech, a drooping face or loss of vision: call 999
- A new or worsening headache after a head injury: go to A&E or call NHS 111
- New head or neck pain with a rash or blisters on the scalp: see your GP promptly, as this may be shingles
- Neck pain after an injury with numbness, weakness or clumsiness in the arms or legs: call 999
How Apollo can help
We start by working out whether your pain behaves like a true nerve pain or like a headache coming from the joints and muscles of the neck, which is more common and treated differently. We examine the upper neck, the muscles the nerve passes through and your nervous system. Care may include gentle hands-on treatment for the upper neck, exercises and advice on the positions that set it off. If the pattern suggests occipital neuralgia that is not settling, we will write to your GP about nerve-pain medicines or referral for a nerve block.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
What does occipital neuralgia feel like?
It feels like a sudden jab, shock or shooting pain that starts at the base of the skull and runs up the back of the head, usually on one side. Attacks last seconds to minutes. The scalp is often sore to touch afterwards.
Is occipital neuralgia the same as a headache from the neck?
No. A cervicogenic headache is a steadier ache referred from the joints and muscles of the neck, and it is more common. Occipital neuralgia is a sharp, shooting nerve pain. They can occur together, and an assessment helps tell them apart.
Will occipital neuralgia go away?
Many people improve with conservative care and time. If the pain persists, a nerve block often gives relief lasting weeks or months, and your GP can refer you for this.
References
- (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1-211. View source
- Choi I, Jeon SR (2016). Neuralgias of the Head: Occipital Neuralgia. Journal of Korean Medical Science 31:479. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
