This page is awaiting validation. It does not replace a consultation or a programme adapted to your situation.
Which nerves are involved?
The occipital nerves carry sensation from parts of the back of the scalp. The greater occipital nerve is sometimes called Arnold’s nerve. Neuralgia means pain in a nerve’s territory; it is not the same as an ordinary tight muscle.
Several neighbouring structures can cause pain felt in this area. Anatomy helps explain the terminology, but does not let you find a trapped nerve yourself by pressing on the neck.
Understand the picture
Nerves at the back of the scalp
Cervical origin
Nerve branches travel towards the occipital region.
Scalp
The nerves contribute to sensation in this area.
Pain
Its territory and character are interpreted with examination.
How can the pain feel?
Brief, sharp, stabbing or electric-shock-like attacks may travel over the back of the scalp. They can last seconds to minutes. Unusual sensitivity when touching the hair or skin may accompany them.
Pain can affect one or both sides and may sometimes be felt further forward. Discomfort between attacks can also occur. Record the character and duration; location alone is insufficient for diagnosis.
Chapter sources [1]
What else can resemble it?
Migraine, tension-type headache and pain from cervical structures may affect the back of the head. Referred muscle pain is not automatically neuralgia. Similar symptoms may need different care.
Pain appearing to follow a line in an illustration does not confirm anything. Report nausea or sensitivity to light rather than trying to place each symptom into a diagnostic category yourself.
Why might a nerve become painful?
Irritation or injury may be associated with trauma, certain neck changes or other conditions. Sometimes no precise cause is identified. Assessment looks for factors that might change investigations or treatment.
Do not conclude from one episode that your pillow, posture or a muscle is responsible. A simple appealing explanation is not necessarily proven. Health history and the course of symptoms matter.
Chapter sources [3]
How is it assessed?
A doctor discusses the pain and examines sensation and neurological signs. Depending on findings, imaging or specialist referral may be considered. No single home test confirms or excludes occipital neuralgia.
In medical care, an anaesthetic nerve block may contribute to diagnosis and sometimes give temporary relief. This is a professional procedure, not an exercise or proof that every headache shares the same cause.
When should you not wait?
Sudden exceptionally severe headache, sudden weakness, speech difficulties, confusion or high fever with stiffness needs urgent help. Call 112 in Luxembourg. A presumed neuralgia must not delay that call.
Seek assessment for new unusual pain, symptoms after an injury or a substantial change in attacks. Jaw pain when chewing with a new headache or visual symptoms also needs urgent medical advice.
What treatments may be discussed?
Options depend on the suspected cause, severity and impact. A doctor may discuss medicines or specialist procedures. Benefits and risks should be explained; this guide recommends no particular medicine or injection.
Difficult persistent pain may warrant specialist review. An invasive procedure is not inevitable and does not guarantee a cure. Accurate diagnosis and follow-up matter as much as the treatment’s name.
Chapter sources [3]
What is the role of physiotherapy?
When neck difficulties coexist, physiotherapy may address movement and activities alongside medical follow-up. It should respect the area’s sensitivity and your response. Improved comfort alone does not establish the exact pain mechanism.
Avoid repeated strong pressure over the presumed nerve and improvised neck manipulation. The aim is not to force a painful spot to release. Worsening or new symptoms need reassessment.
Chapter sources [3]
What can you do between appointments?
Record attack frequency, duration, sensations and associated symptoms. Notice activities or contact that appear to trigger them and seek comfortable adjustments without routinely immobilising the head.
General neck exercises are not an automatic treatment for neuralgia. Ask which are suitable. If activity repeatedly produces shooting pain, reduce it and discuss the response rather than pushing through to become accustomed to it.
In everyday life
Making attacks easier to describe
Character
Shock, burning, duration and side.
Impact
Sleep, hair contact and activities.
Course
Report new symptoms or changing frequency.
What course and follow-up can you expect?
There is no single recovery timeline. Progress depends on the cause, diagnosis and response to the measures tried. Monitoring sleep, activities and attack frequency provides concrete ways to assess change.
If a treatment helps only briefly, symptoms persist or the picture changes, review the plan. The clinician may revisit the diagnosis or suggest another opinion. Regular follow-up helps avoid repeating care without clear objectives.
Chapter sources [3]
Your questions
Is every pain at the back of the head occipital neuralgia?
No. Muscles, joints and several headache types can cause pain there. Attack characteristics and examination help guide diagnosis.
Chapter sources [1]
Can I find the nerve by pressing behind my head?
A tender area does not confirm neuralgia. Repeated pressure may irritate the region and cannot replace examination.
Chapter sources [1]
Does a nerve block provide a permanent cure?
Its effect may be temporary and its role varies. The clinician should explain why it is proposed, the expected benefit and possible risks.
Chapter sources [3]
Should I stop every activity?
Not automatically. Adapt poorly tolerated tasks and keep comfortable activities according to advice. Specific exercises should follow assessment.
Chapter sources [3]
Sources and references
- [1] International Headache Society — ICHD-3: occipital neuralgia
- [2] NICE CG150 — Headaches in over 12s: recommendations
- [3] AANS · Occipital neuralgia
- [4] NHS — Tension headaches
- [5] NHS · Stroke symptoms
- [6] CGDIS Luxembourg · 112
- [7] NHS Inform · Exercises for neck problems
- [8] NICE NG127 · Dizziness and vertigo in adults
Text updated on
Medical review: awaiting Hasib Selimovic.