Occipital neuralgia, a relatively rare primary headache disorder, can be confused with migraines. Both conditions have similar symptoms of chronic head pain. However, migraines typically cause pain on one side of the head or the other, whereas someone suffering from occipital neuralgia suffers pain towards the back of the head.

In both cases, the pain is chronic and debilitating. Fortunately, some of the same treatments that ease the symptoms of migraines also relieve occipital neuralgia symptoms.

What Is Occipital Neuralgia?

Occipital neuralgia (ON) literally translates as “a pain in the back of the head caused by a nerve.” The most common nerves implicated in this condition are the Greater and Lesser occipital nerves that ascend from the upper portion of your spinal cord into the neck and up both sides of your head near the ears. The occipital nerves provide sensation to the back of your head.

When these nerves are compressed for long periods due to muscle tightness or other issues, pain is often the result. ON may also be caused by concussive trauma to the occipital nerves; repetitive neck contraction, flexion, or extension; or certain medical complications and conditions.

Occipital neuralgia causes episodic, brief, severe, and shock-like head or neck pain. It affects about 0.0032% of the population annually. Migraines, on the other hand, last much longer than episodes of ON and affect 13% of American adults.

A disorder known as spasmodic torticollis is a chronic neurological disorder that creates similar neck pain. However, it is differentiated from ON by the symptoms. Spasmodic torticollis, also called cervical dystonia, causes the neck to turn involuntarily to the left, right, upward, or downward, creating neck pain.

Symptoms of Occipital Neuralgia

Pain from occipital neuralgia tends to be piercing, sharp, or stabbing, and can be severe. You may feel unpleasant sensations near the occipital nerves along the back of your neck and head. You may also have tenderness along the nerve pathway. The attacks can lack from a few seconds to several minutes but are not as long-lasting as migraines.

Occipital neuralgia tends to cause pain in these areas.

  • Back or top of the head
  • Behind the eyes
  • Upper neck

Some sufferers are sensitive to light, also a common trigger for migraines. If the condition becomes severe, it can result in difficulty with balance and coordination, nausea, or vomiting. ON can be triggered by common daily activities such as hair brushing, wearing a hat, or placing your head on a pillow.

Treating Occipital Neuralgia

Occipital neuralgia may respond to simple treatments such as warm compresses, massage, and physical therapy. Anti-inflammatory medications and muscle relaxers can also provide some relief. When these treatments do not work, there are several more aggressive methods to relieve the symptoms


Neurostimulation applies gentle, electric stimulation via an implanted device with wires and a battery. The wires are placed under the skin near the nerves creating the problem. Neurostimulation is used successfully to reduce 80% to 100% of migraine pain and has been similarly successful in treatment for ON.

Dr. Khorsandi has teamed up with anesthesiologist Dr. David Leiman, to provide targeted nerve blocks in the operating room, under neurostimulation and ultrasound guidance.  Targeting the tissues with pinpoint accuracy around the occipital nerve, we have been able to provide patients with longer relief than a traditional occipital nerve block.  Our average patient experiences 4-6 months or longer of migraine relief.

Occipital Nerve Block

Blocking the occipital nerve by injecting a steroid or other medication near the Greater and Lesser occipital nerves reduces inflammation and swelling of tissues that may be compressing the nerves and causing pain.

Pain across the back of the head often respond well to a nerve block.


BOTOX, used cosmetically for years, has been found to relieve migraine and ON symptoms when injected near the nerve triggering the pain. People treated with BOTOX must receive injections every three months to maintain effective pain relief.

Radiofrequency Ablations

Radiofrequency ablation is performed by inserting a needle-like probe near the nerve cluster causing the symptoms. Radio waves are then used to create an electric current to heat up the nerve endings and provide relief similar to a nerve block. If you respond well to nerve blocks, you may be a good candidate for RFA.


When patients with occipital neuralgia do not respond to other treatments, surgery is the next step. The goal of this type of surgery is headache and pain reduction. Occipital neuralgia is often caused by compression of the nerves over time. Surgery seeks to relieve the pressure on compressed nerves to reduce the frequency, severity, and duration of headaches, and perhaps eliminate them entirely.

Get started today. Let our migraine specialists show you how we can help.