Occipital Neuralgia: What It Is and How to Treat It

03 October 2019

Occipital neuralgia occurs when the nerve(s) is compressed or aggravated.  The two occipital nerves originate in the cervical spine between the second and third vertebrae.  They branch and innervate the back of the head and side of the scalp to provide sensation to these areas.   

It’s complicated.

Occipital neuralgia is an ambiguous diagnosis.  It can be a singular issue caused by excessive pressure directly on the nerve.  The most common areas of overpressure are directly at the spine or from the muscles that are at the base of the skull that the occipital nerve runs through.  Plus, neuralgia can be a contributing factor to similar issues like chronic migraines and tension headaches.  Lastly, it can be a side effect of other health issues.  For these reasons, it’s important to talk to a health care professional to help differentiate the cause of your pain and correctly treat it.

Symptoms of occipital neuralgia.

  • Deep aching pain that originates from the upper neck or base of the skull.
  • Radiating pain across the side of the head, possibly into the temples and/or eye (typically only affecting one side).
  • Pain that increases with stress and prolonged sitting.
  • Shooting, sharp pain in the areas that the occipital nerve innervates.
  • Sensitivity to touch on the scalp, such as wearing a hat or using a hair brush.
  • Discomfort with movement of the head and neck that may trigger any of the symptoms listed above.

Causes of occipital neuralgia.

  • Poor posture.  Having the head too far forward strains the neck and upper back muscles, making them tight.  Plus, poor posture puts excessive direct pressure on the muscles at the base of skull and the occipital nerves that run through them.
  • Muscle tension.  Whether it’s from a prolonged sitting activity, a lifting strain, or sleeping funny, unwarranted tension in the neck can put too much pressure on the occipital nerves.
  • Spine degeneration, including osteoarthritis and disc herniation.   These issues are common with aging, hereditary factors, and a history of trauma to the neck.
  • Diabetes.   Nerve damage is a normal issue with diabetes.  Although it’s more likely to affect nerves in the hands and feet, it can affect the occipital nerves as well.  
  • Trauma to the neck or head.  This can lead to fracture, swelling, poor circulation, and instability of the spine that can all contribute to strain on the occipital nerves.
  • Other illnesses. Issues such as autoimmune disease, infection, cancer, and gout can cause systemic issues like inflammation and poor circulation.

Treatment options.

  • Physical therapy. A trained eye can help identify your problem areas to address posture and daily activities.  They can help you figure out pain triggers and restore balance to the neck through proper strengthening, stretching, education, modalities, and massage.
  • Massage therapy. When those tight neck muscles just won’t let up, a deep tissue massage that primarily focuses on problem areas in the base of the skull and top of the shoulders can make a big difference.  There are also great techniques for home self-massage to address occipital neuralgia as well.  You may even consider getting a home massage unit for your neck and shoulders.
  • Exercise.  Simply getting moving can promote release of the body’s endorphins (natural pain relief), promote better circulation to the occipital nerves, and improve stress management skills.  These can all help get the pain symptoms under control.
  • Modalities.  Anything that can help you relax and relieve pain is a great option.  This includes heat, cold, and electrical stimulation (TENS).
  • Workplace and home ergonomics. Better attention to your posture and daily movements can quickly improve symptoms.  If sitting is a must, make sure to take frequent stretching breaks.  Otherwise, consider options like a workstation or standing desk (both allow alternating between sitting and standing).  These help optimize posture, limit muscle fatigue and tension, and even boost productivity.  
  • Medication. Talk to your doctor about short term options for pain relief until you can better manage your symptoms with the options above.  Anti-inflammatories, muscle relaxants, and/or nerve medications may be prescribed.
  • Nerve blocks. This invasive option involves an injection directly at the site of irritation in the cervical spine.  This is an option if conservative treatment fails or pain is severe.
  • Surgery as a last resort. If all conservative treatment options fail, surgery is the last possibility, although it is not commonly used.  It involves a release of any affected tissues causing excessive pressure to the occipital nerve.


Nerve irritation of any kind is no fun, especially when it radiates into the head and eye(s).  These symptoms make it hard to focus and enjoy life.  Luckily, with a little understanding and treatment occipital neuralgia is manageable.  With proper treatment, a full recovery is completely possible so that you can continue to live life to the fullest!