Headaches are a common ailment that vary in pain intensity and location. Although most headaches prove a temporary nuisance, some are more concerning and disruptive. Occipital headache pain, located over the back of the head, can arise from a variety of causes. Nerve, muscle, blood vessel and bone abnormalities are among the common causes of occipital headaches. Determining the underlying cause of an occipital headache is the essential first step in treating this condition.
Occipital Neuralgia
The occipital nerves arise from the upper spinal cord and branch out over the back of head, supplying sensation to the region. Occipital headaches frequently occur due to irritation of one or both of the occipital nerves. Most patients with this disorder, known as occipital neuralgia, experience pain originating at the base of the skull and radiating to one side of the back of the head. Some patients report throbbing, aching or burning pain; others experience shooting or shock-like pain.
The American Association of Neurological Surgeons notes that a variety of medical conditions can provoke occipital neuralgia. Arthritis of the upper neck vertebrae and age-related degeneration of the intervertebral disks in this region commonly provoke occipital neuralgia. Less frequent causes of occipital neuralgia include spinal cord tumors, traumatic injuries involving the occipital nerves and inflammatory blood vessel disorders.
Head, Neck and Skull Trauma
Traumatic injuries to the back of the head, base of the skull or the uppermost bones of the spine can cause a sudden occipital headache. Fractures and dislocations of the upper spine, also known as the cervical spine, are particularly concerning because permanent spinal cord damage can occur with these injuries.
Soft tissue neck injuries, such as whiplash, may lead to chronic occipital headaches. Headaches arising from abnormalities of the soft tissues or bones of the neck are called cervicogenic headaches. In an April 2005 article published in the "Journal of the American Osteopathic Association," Dr. David Biondi notes that cervicogenic occipital headaches usually involve one side of the head and cause nonthrobbing pain that may continue for hours to days. Specific types of head movements and certain neck positions may trigger a cervicogenic occipital headache.
Subarachnoid Hemorrhage
A subarachnoid hemorrhage is a brain bleed into the space occupied by the cerebrospinal fluid. These bleeds most commonly occur when an abnormally ballooned blood vessel in the brain--a cerebral aneurysm--bursts. Head trauma can also cause a subarachnoid hemorrhage.
The blood accumulation in the brain caused by a subarachnoid hemorrhage triggers a sudden severe headache, typically arising over the back of the head. Patients routinely describe the headache associated with a subarachnoid hemorrhage as the most painful headache they have ever experienced. Other symptoms of a subarachnoid hemorrhage include neck pain, visual disturbances, nausea and vomiting.
A subarachnoid hemorrhage is a medical emergency; the condition can prove rapidly fatal without medical intervention. New York-Presbyterian Hospital reports that eight to 15 percent of patients with an aneurysm-related subarachnoid hemorrhage die within the first 24 hours of the bleed.
References
- American Association of Neurological Surgeons: Occipital Neuralgia
- National Institute of Neurological Disorders and Stroke: Occipital Neuralgia
- "Journal of the American Osteopathic Association"; Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies; David M. Biondi, D.O.; April 2005
- University of Maryland Medical Center: Skull Fracture
- New York-Presbyterian Hospital: Cerebral Aneurysms and Subarachnoid Hemorrhage
