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-type headaches or migraines. New-onset occipital headaches are a more urgent concern. Possible causes include blood vessel abnormalities, nerve disorders and serious traumatic injuries.
Tension-Type Headache and Migraines
Tension-type headaches are the most common form of headache. Although the pain is often described as a non-pulsating, pressure sensation around the top of the head, it can also occur at the back of the head in some people. The pain typically involves both sides of the head, is of mild to moderate intensity and is not accompanied by symptoms such as nausea, vomiting or sensitivity to light or sound.
Migraine headaches provoke throbbing pain on one side of the head. In some people, however, the pain can occur primarily in the back of the head and the upper neck. The pain of a migraine usually builds with time. Nausea, vomiting, and sensitivity to light and sound frequently occur with migraines.
Cervicogenic headaches arise from a problem in the neck that leads to pain in the back of the head. Neck pain and stiffness typically accompany these headaches. Cervicogenic headaches are a common causes of back-of-the-neck headaches. The pain may be on one or both sides of the back of the head, and is often aggravated by certain neck positions -- especially tilting the head back, or rotating the head toward the side of the pain. The pain is believed to occur due to problems in the cervical spine, meaning the portion of the spine in the neck region. It can occur with traumatic injuries, such as whiplash, or long-term problems, such as a bulging cervical disc or arthritis of the cervical spine.
Occipital neuralgia refers to 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. The pain is often described at shooting or stabbing in nature. The skin over the area of pain might be tender and feel numb or tingly. Possible causes of occipital neuralgia include tumors in the neck, inflammation of nearby blood vessels, 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.
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. Head trauma is the most common cause of this type of bleeding. A rupture of ballooned blood vessel, or aneurysm, in the brain is another common cause of a subarachnoid hemorrhage. A sudden, severe headache in the back of the head is the hallmark symptom of a subarachnoid hemorrhage. Other symptoms may include nausea, vomiting, confusion, visual disturbances and decreased level of consciousness. A subarachnoid hemorrhage is a medical emergency.
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. A basilar skull fracture is a serious injury, typically requiring in-hospital monitoring. The occipital bone in this area is thick and 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. Watery 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.
Warnings and Precautions
Headaches in the back of the head are relatively common. The most common causes are not life-threatening and can usually be managed. Medical evaluation is needed, however, to identify the specific cause and appropriate treatment. Additionally, it's important to recognize signs and symptoms that might indicate a serious problem. Signs, symptoms and circumstances that necessitate immediate medical care include:
-- headache that develops after a blow to the head
-- sudden, severe headache that comes on like thunderclap
-- worst headache of your life
-- loss of consciousness, drowsiness or confusion
-- fever and neck stiffness
-- weakness or loss of control of part of your body
-- pain that wakes you up
Reviewed and updated by: Tina M. St. John, M.D.