Headaches in the back of the head may be caused by a variety of ailments and injuries. Chronic headaches in the back of the head--also known as occipital headaches--are often variants of tension headaches or migraines. New-onset occipital headaches are a more urgent concern. Possible causes include blood vessel abnormalities, nerve disorders and serious traumatic injuries.
Three protective tissue layers called the meninges protect the brain. The pia mater covers the brain surface. The arachnoid mater is the middle layer of the meninges. The dura mater is the outermost meningeal layer. A subarachnoid hemorrhage is bleeding that occurs between the pia mater and the arachnoid mater. A severe headache in the back of the head is the hallmark symptom of a subarachnoid hemorrhage. Other symptoms associated with subarachnoid hemorrhage include nausea, vomiting, confusion, visual disturbances and decreased level of consciousness. A subarachnoid hemorrhage is a medical emergency.
Occipital neuralgia is an irritation of the occipital nerves, which causes severe pain in the back of the head. The occipital nerves emerge from the spinal cord at the top of the back of the neck, and fan out over the scalp. The headache of occipital neuralgia follows the path of the nerves, and is usually limited to one side of the head. Possible causes of occipital neuralgia include tumors in the neck, vasculitis, arthritis, injury and having the head tilted forward for lengthy periods. Notably, there are no brain-related symptoms associated with occipital neuralgia. Anti-inflammatory medications, resting the neck and muscle relaxant medications are the primary treatments for occipital neuralgia.
Basilar Skull Fracture
Basilar skull fractures are those that occur in the lowest part of the skull, where the spinal cord enters. The occipital bone is the primary location of basilar fractures. Basilar skull fractures typically cause severe headache over the back of the head. The University of Chicago Medical Center notes that a basilar skull fracture is a serious injury, typically requiring in-hospital monitoring. The occipital bone in this area is thick; substantial force is required to cause a basilar fracture. Hence, the risk of underlying brain injury is high with a basilar skull fracture. A common complication of basilar skull fracture is the development of a spinal fluid leak due to tearing of the meninges. Spinal fluid may seep from the ear or nose. Other symptoms of basilar skull fracture include loss of the sense of smell, hearing loss, visual disturbances and bruises behind the ears or surrounding the eyes.