Tension headaches are the most common type of headache by a wide margin. Only a few types of headaches typically produce pain in the back of the head, called the occipital area, and base of the neck, termed the upper cervical spine. The junction between where the upper cervical spine attaches to the occiput is termed the sub-occipital region, which is rich in nerve fibers, joints and small muscles, all of which are capable of generating pain.
Excessive Muscle Tension
Although not completely understood, tension headaches are assumed to be partly related to excessive muscle tension and contraction in the upper shoulders, neck, sub-occipital region and scalp. The excessive muscle tension is usually caused by sustained stress and poor posture, which leads to inflammation and dull, achy pain. Tension headaches produce mild to moderate levels of diffuse pain distributed around the head in a band-like pattern that includes the back of the head and base of the neck.
MayoClinic.com adds that tension headaches may also result from changes among certain brain chemicals, such as serotonin and endorphins, which activate pain pathways and interfere with the brain's ability to suppress pain. In addition to stress and poor posture, jaw clenching, depression, dehydration and weak muscles could contribute to tension headaches and pain at the base of the neck.
Upper Neck Dysfunction
The upper cervical vertebrae of the neck are vulnerable to injury and dysfunction, as they act as the base for the head and are required to move in various directions. When the muscles, tendons, ligaments, joints or nerves of the upper neck are injured, pain is produced locally, but a cervicogenic headache might also develop. An article in "The Journal of the American Osteopathic Association" defines cervicogenic headache as occipital or sub-occipital pain that originates from injury to nerves of the neck, often the trigeminal nerve complex, or the small apophyseal joints of the neck.
Cervicogenic headache pain is usually dull and localized near the base of the head, although it can become sharp with sudden neck movements and spread up to the top of the head. Upper neck dysfunction can be caused by osteoarthritis, rheumatoid arthritis, apophyseal joint impingement or dislocation, nerve root irritation, and bulging intervertebral discs. Trauma, such as neck whiplash from a car accident, poor posture, stress and increased age all increase the probability of cervicogenic headaches and neck pain.
Disease Processes
If a tension or cervicogenic headache can be ruled out, then it is possible that headache pain in the base of the neck can be caused by disease processes. In addition to arthritis, rarer diseases and conditions that could cause pain in the upper neck and base of the head would include spinal meningitis, which produces severe shooting pains up the spine into the head; brain abscesses, which could form in the occipital area of the skull; Paget's disease, which is a type of cancer that can eat away bone of the skull; brain tumors such as meningiomas, which could put pressure on sensitive structures at the base of the neck and head; and brain aneurysms, which can produce sudden, excruciating pain anywhere in the skull. The Centers for Disease Control and Prevention notes that both bacterial and viral meningitis often start with a headache and a stiff neck, but usually also include fever, nausea and sensitivity to light.
References
- National Institute of Neurological Disorders and Stroke: Headache Information
- MayoClinic.com: Tension Headache Causes
- "The Journal of the American Osteopathic Association"; Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies; David Bionbi D.O.; April 2005
- Centers for Disease Control and Prevention: Meningitis Symptoms
- "Chiropractic Management of Spine Related Disorders"; Meridel Gatterman D.C.; 2001
