Occipital Neuralgia Treatment

Medically reviewed by Joshua L. Hare, DO, Founder & Medical Director

Headache pain that starts at the base of the skull

Occipital neuralgia is pain in the back of the head along the territory of the occipital nerves,[1] which climb from the top of the neck up the scalp. It typically arrives as stabbing or electric attacks lasting seconds to minutes,[1] usually starting at the base of the skull and shooting upward, often with a scalp tender enough that brushing your hair is uncomfortable. It almost always results from compression or irritation[1] of one of these nerves. At IPC, the occipital nerve block is both the confirming test and the first interventional treatment — relief while the anesthetic works establishes the diagnosis[1] — and peripheral nerve stimulation is an option for pain that keeps returning.

Symptoms of occipital neuralgia

The attacks have a recognizable signature:

• Sudden stabbing, shooting or electric pain that starts at the base of the skull and travels up the back of the head, on one or both sides
• Attacks lasting seconds to minutes, sometimes arriving several in a row
• Tenderness of the scalp, often noticed when you rest that side of your head on a pillow
• Tingling, numbness or heightened sensitivity over the same area between attacks
• Pain set off by pressing at the spot where the nerve emerges at the base of the skull

A steady, constant ache that never spikes points away from occipital neuralgia — the attack pattern is part of the diagnosis, which is why a careful history counts for more here than any scan.

When to see a pain specialist about occipital neuralgia

Recurring attacks of stabbing pain at the back of the head justify an appointment once over-the-counter medication has stopped holding them. Because the diagnosis rests on a numbing injection rather than imaging, a pain specialist can usually confirm or exclude it at the first visit.

A sudden, severe headache unlike any you have had before, or a headache with fever, a stiff neck, confusion, weakness or vision changes, needs emergency care rather than a clinic appointment.

Treatment options for occipital neuralgia

Treatment is sequenced by how the pain responds. Medications used for nerve pain — anticonvulsants and certain antidepressants among them[1] — may quiet the attacks. The occipital nerve block settles the diagnosis and treats it in the same visit, and an injection with steroid can occasionally hold for several months.[1] For pain that responds to blocks but keeps coming back, nerve stimulator leads placed across the base of the skull[1] are the longer-term option.

References

Clinical sources for this page.

1. Occipital Neuralgia. StatPearls [Internet], National Library of Medicine; updated March 6, 2023. Back to first citation ↑
2. Occipital Nerve Block. StatPearls [Internet], National Library of Medicine; updated July 30, 2025.