Pain in the back of the head is a common migraine symptom. But it’s also a symptom shared by other headache disorders, which means it’s sometimes difficult to determine if this kind of pain is migraine or something else. According to Dr. Rashmi Halker Singh of Mayo Clinic, one such condition is occipital neuralgia.
“It can be a little tricky to really diagnose occipital neuralgia,” Dr. Halker Singh says. “A lot of times patients have other headache problems, so there can be some overlap between this condition and other problems such as migraine.”
Dr. Halker Singh recently spoke with the American Migraine Foundation about the diagnosis and treatment of occipital neuralgia, and explains more about its association with migraine.
Occipital Neuralgia Diagnosis
Dr. Halker Singh says occipital neuralgia is defined as pain over the back of the head, neck and scalp, which is known as the occipital head region. It is characterized by a sharp, shooting pain that can be triggered by things like turning your head or pushing on the affected area.
Dr. Halker Singh says it’s important to tell your doctor if you’re experiencing neck or occipital pain. She highlights that both of these are common migraine symptoms, but if the pain is not accompanied by other typical migraine symptoms like nausea or light sensitivity, it may be occipital neuralgia instead.
Dr. Halker Singh notes that it’s rare for someone to have only occipital neuralgia. More often, patients will seek help for migraine and discover this condition during the evaluation.
“It’s not uncommon for people with migraine to also have occipital head pain,” Dr. Halker Singh says. “If a patient comes to see me and they have neck and occipital head pain, I would take all of that into account.”
Occipital Neuralgia Treatment
Occipital neuralgia may respond to conservative treatments. Dr. Halker Singh suggests maintaining a healthy lifestyle with regular exercise, stretching, and yoga. She recommends people incorporate these activities even before making an appointment with a doctor because they can make a big difference.
If these strategies are not effective, occipital nerve blocks or neck injections may be necessary. Occipital neuralgia that doesn’t respond to conservative treatments may require daily preventive medication.
Dr. Halker Singh also points to neuromodulation devices, which stimulate or interrupt nerve impulses and can improve headache symptoms. Dr. Halker Singh notes that there are no neuromodulation devices that have approval for occipital neuralgia. She adds, however, that patients with migraine who experience occipital pain may find these devices helpful, since the pain may be caused by migraine. Migraine itself can be successfully treated with certain neuromodulation devices.
Migraine and occipital neuralgia have a very complex relationship, Dr. Halker Singh says. When both types of pain are present, it’s not easy to tell what is causing what.
“Sometimes, we don’t have a great answer about the root of the problem until we try treating both conditions to see what happens,” Dr. Halker Singh says. “By treating migraine, a person’s neck pain might get better, but it’s not always ‘A equals B’—it goes both ways.”
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Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.