Headache in the Back of the Head

A headache experienced in the back of the head can have many different causes. Most of these causes can be identified by specific symptoms, such as the exact location of pain and the type or severity of pain experienced. In some cases, certain events can trigger these headaches.  

Causes

Doctors can diagnose and treat headaches according to your symptoms, types of pain, and location of pain. Some of the common causes of pain in the back of the head include:

1. Bad or Poor Posture

Pain in the back of the head and neck can be due to poor body positioning or posture, which creates tension in the neck, shoulders, and back. This tension may also cause headaches that are characterized by a throbbing, dull pain at the skull’s base. 

For treatment, acetaminophen can be used for headaches that are caused by poor posture. To help prevent these headaches, make sure to improve your body’s positioning by sitting with both of your feet on the ground and using an ergonomic work chair that has good lumbar support. 

2. Arthritis

Swelling and inflammation in the neck region may be caused by arthritis headaches. In this condition, more intense pain may be experienced as you move. Although any form of arthritis can cause pain in the back of the head and neck, the most common causes are osteoarthritis and rheumatoid arthritis. 

Anti-inflammatory medications are often used to reduce inflammation and pain in people with arthritis headaches. 

3. Occipital Neuralgia

Occipital neuralgia is a type of headache that occurs when the occipital nerves, which are nerves that run from your spinal cord to the scalp are injured or damaged. In most cases, this condition is confused with migraine headaches.

Its main symptom is a sharp, throbbing, and chronic pain behind the ears, back of the head, and upper neck. Pain is usually experienced on one side of the head near the base of the skull. Other symptoms of occipital neuralgia include:

• Neck pain whenever you move your head
• Scalp tenderness
• Light sensitivity
• Pain behind your eyes
• An electric shock or stabbing sensation in the back of the head and neck

Treatment for occipital neuralgia usually involves a combination of medications and therapies, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Prescription muscle relaxant drugs
• Massage
• Physical therapy
• Warm or heat therapy

Patients with severe occipital neuralgia may need local anesthetic injections into the affected area for immediate pain relief. However, this mode of treatment may last up to 10-12 weeks. 

4. Herniated Disks

A herniated disk is one of the most common sources of pain in the back of the neck. Other terms for a herniated disk is a ruptured disk or a slipped disk. This condition usually occurs in your lower back, including the smaller disks that are located in your neck.

Herniated disks in the neck can cause tension and neck pain, and can cause cervicogenic headaches, which tend to get worse whenever you lie down. In fact, some people may have poor sleep since the pain disrupts their sleep. Pressure on top of your head may also occur when lying down. Discomfort in your upper arms and shoulders may also be experienced when you have a herniated disk.

Pain in the back of the head due to a herniated disk is usually treated by any of the following therapies:

• Gentle stretching
• Physical therapy
• Chiropractic care and manipulation
• Epidural injections for pain and inflammation
• Surgery (if needed)

Most people tend to feel better after a few months of using nonsurgical treatments.  

5. Migraine Headaches 

Most people who have migraine headaches experience pain at the back of head or on the left side of the head. However, migraine headaches can also start in other locations.

Symptoms of a migraine headache often include:

• Sensitivity to light or sound
• Auras
• Nausea
• Vomiting
• Watery eyes
• Severe, pulsating, or throbbing pain 

Preventative medications such as beta-blockers may be prescribed by doctors for the treatment and prevention of migraine headaches. Over-the-counter medications like Excedrin Migraine may also work for mild migraine headaches. Avoiding the things that can trigger your migraines can also help. 

6. Tension Headaches

Tension headaches typically occur in the back of the head, particularly on the right side. This type of headache is one of the most common causes of pain in the back of the head. Pain from tension headaches is often described as a tight, constricting pain in the neck or scalp. 

Over-the-counter analgesics or painkillers can be used for the treatment of tension headaches. However, people with severe and chronic tension headaches may need prescription medications from their healthcare provider.

Aside from pain relievers, doctors may also prescribe other medications, such as muscle relaxants and antidepressants to lessen the recurrence of tension headaches. 

7. Cluster Headaches

Although cluster headaches are rare, they can be extremely painful. This type of headache is called cluster headaches because they usually occur in cluster periods, which may last for weeks up to months.

These headaches may also cause pain on either side of the head, including the back of the head, and may become more painful when lying down.

Other symptoms of cluster headaches are:

• Sensitivity to light or sound
• Drooping eyelid
• Excessive tearing
• Stuffy nose
• Nausea
• Sharp pain
• Penetrating or burning pain

The aim of cluster headache treatment is to reduce the severity of the attacks, shorten the periods of headaches, and prevent recurring attacks. Treatment may include the use of the following medications:

• Local anesthetics
• Triptans
• Octreotide injection
• Nerve blockers
• Corticosteroids
• Melatonin

Surgery may be recommended by doctors in extremely severe cases. 

Effective treatment usually depends on the main cause of headaches. Most types of headaches can be relieved using over-the-counter pain relievers, such as Tylenol (acetaminophen). For people with chronic headaches, other medications, such as Extra-Strength Tylenol may help.

Physical Stimulus

A number of physical stimuli can prompt headaches. Headaches will disappear if changes occur in the surroundings. 

• High Altitude: This can cause headache in the back of the head of mountain climbers. Pain can be localized or can occur in the entire head. Pain also worsens with exertion.

• Cough: Headaches can also be triggered by coughing. Chiari malformation is the most common cause. Cough-induced headaches in the back of the head can occur due to stiff neck joints or muscular problems.

• Orgasm: Sudden and severe pain in the occipital area can occur during sexual activity. This type of headache occurs due to reversible cerebral vasoconstriction syndrome (RCVS). 

• Playing Pool: Extended period of playing pool can cause pain in the neck joint and back of the head. 

• Dialysis: Headaches can also be experienced after dialysis sessions. People who have high blood pressure and are undergoing dialysis treatment are more prone to headaches. 

Trapped Nerves

Headaches can occur when muscles, bones, or blood vessels trap certain nerves. Pain relief can be achieved by treating the underlying condition. 

• Occipital Condyle Syndrome: Severe occipital pain occurs in people with this condition. Pain also arises when cancer spreads to the occipital bone.

• Accessory Nerve Palsy: When the accessory nerve is damaged, pain arises in the neck, shoulder, and back of the head.

• Hypoglossal Nerve Palsy: This condition occurs when the nerve gets inflamed in the hypoglossal canal. 

Diseases

Headache in the back of the head may also occur due to certain medical conditions, which include:

• Parkinson’s Disease: People who have low blood pressure associated with Parkinson’s disease may experience headaches in the back of the head. Pain is often described as though being suspended on a coat hanger. 

• Brain Tumor: Even though a headache in the back of the head is not a characteristic feature of a brain tumor, such pain may be experienced in some cases.

• Sleep Apnea: People with sleep apnea and chronic headaches are more prone to experiencing pain in the back of the head. 

• Dengue Fever: Headaches with fever are one of the common symptoms of dengue fever. Around 96 percent of people with dengue fever tend to experience prominent headaches. 

When to Seek Medical Help

If you experience any of the following symptoms, call your doctor right away:

• Headaches that disrupt your normal daily routine
• New headaches that extend for more than a few days
• Headaches that are accompanied by tenderness in the temples
• Changes in the pattern of your headaches
• Severe or worst headache that you have ever experienced
• Worsening headaches

References

Arthritis. The National Headache Foundation. (2007). https://headaches.org/2007/10/25/arthritis/

Herniated Disk. OrthoInfo-AAOS. (2018). https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk/

Migraine - Symptoms and causes. (2018). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201

Cluster headache - Symptoms and causes. (2018). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080

Use of Beta-Blocker Ophthalmic Solution for the Treatment of Migraine. The National Headache Foundation. (2016). https://headaches.org/2016/07/01/use-beta-blocker-ophthalmic-solution-treatment-migraine/

The Complete Headache Chart. The National Headache Foundation. (2018). https://headaches.org/resources/the-complete-headache-chart/