Occipital neuralgia is a painful condition that occurs when the occipital nerves that run from the top of your spine to your scalp are compressed or irritated.

Occipital neuralgia symptoms and causes

If you have occipital neuralgia, you may experience one or more of these symptoms:

  • Throbbing, aching pain or sharp, electric-like pain that typically starts where the back of your head meets your neck.
  • Pain that radiates to one side of your head, down your neck and/or back.
  • Pain behind your eye.
  • Increased sensitivity of your scalp.

See Occipital Neuralgia

These symptoms can be caused by irritation of the occipital nerves along their path, which may occur:

  • Spontaneously, as a result of a pinched nerve root in your neck due to an injury or surgery. Commonly the roots of C2 and/or C3 at the top of your cervical spine are affected.

    See The C1-C2 Vertebrae and Spinal Segment

  • Due to irritation/compression from tight neck muscles. This muscle tightness may be associated with physical or emotional stress.

See Cervical Spine Anatomy

The exact cause of occipital neuralgia may not always be determined. You may experience migraines or tension headaches simultaneously with occipital neuralgia.

See How Neck Pain and Headache Can Occur Together


Finding occipital neuralgia pain relief

Here’s how you can ease painful occipital neuralgia symptoms:

  • Apply ice/heat therapy. Ice therapy may reduce local inflammation and relieve pain. Tuck an ice pack under the base of your skull as you lie down. However, you may find more relief using heat therapy, such as an electric heating pad. When you apply heat to the affected area, local blood vessels are dilated and blood flow to the neck increases, which can reduce muscle tightness. Don’t apply the cold/heat source for more than 20 minutes at a time. Always use a barrier, such as a hand towel, between your skin and the cold/heat source.

    See How to Apply Heat Therapy

  • Take NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAID) are over-the-counter medications such as ibuprofen (e.g., Advil, Motrin) and naproxen (e.g., Aleve). Taking them may help reduce inflammation and relieve headache/neck pain. Follow the instructions on the labels and discuss with a physician or pharmacist to make sure you’re using these medications safely.

    See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

  • Give yourself a neck massage. Apply gentle pressure from your fingertips at the base of your skull. This massage can help calm tight muscles and release tension. You can also place a rolled towel under your head and neck as you lie down on your back. The pressure from the towel can provide a gentle massage. Stop immediately if the massage aggravates your pain.

    See Massage Therapy for Chronic Stiff Neck

  • Do chin tucks regularly. Some cases of occipital neuralgia may be related to poor posture stressing the nerves. The chin tuck exercise aims to stretch the muscles and connective tissue in the painful area and strengthen the muscles that align your head over your shoulders. Stand with your upper back against a wall, feet shoulder-width apart. Face forward, tuck your chin down, and pull your head back until it meets the wall. Try to bring your head back in a straight line without tilting it back or nodding forward. Hold the stretch for 5 seconds before resting, and repeat 10 times. If this exercise increases pain or discomfort, stop immediately.

    See Easy Chin Tucks for Neck Pain

If these self-care tips don’t ease your occipital neuralgia pain, visit a health care provider. You may find relief through prescribed pain medications and/or a guided physical therapy program. A doctor may even consider offering a steroid injection to help relieve inflammation and reduce the pain.

See Treatment for Neck Pain

Learn more:

Physical Therapy for Neck Pain Relief

Neck Exercises for Neck Pain

Dr. Zinovy Meyler is a physiatrist with over a decade of experience specializing in the non-surgical care of spine, muscle, and chronic pain conditions. He is the Co-Director of the Interventional Spine Program at the Princeton Spine and Joint Center.