Occipital neuralgia

Occipital neuralgia is sharp, shooting, or electric pain from the greater or lesser occipital nerves at the base of the skull. It can feel like a jolt that travels up the back of the head.

What it feels like

Pain often starts at the base of the skull and shoots upward on one or both sides. A burning or aching baseline can sit between the sharper jolts.

Scalp tenderness is common. Brushing hair, wearing a hat, or pressing near the occipital notch can provoke symptoms.

Some people notice neck tightness with the nerve pain. True visual aura and classic migraine nausea are less central, though mixed pictures exist.

What is going on

The greater and lesser occipital nerves arise from the upper cervical roots and travel through muscle and fascia at the base of the skull.

Irritation can come from muscle entrapment, local trauma, posture load, or nearby cervical joint problems.

Occipital neuralgia can look like migraine or cervicogenic headache. Careful exam and, when needed, a diagnostic block help separate them.

How we evaluate

We map the pain path, check occipital notch tenderness, and look for cervical findings that might be upstream.

Neurologic screening watches for red flags that would push imaging or specialty referral sooner.

Imaging is selective: new severe pain, progressive neurologic change, trauma, cancer history, or an atypical course. Not every classic case needs an MRI first.

What we may offer

An occipital nerve block can both clarify the diagnosis and settle flares when the greater or lesser occipital nerves are the source.

Medication management may include nerve-pain oriented options when appropriate. Physical therapy addresses soft tissue and cervical contributors.

If cervical facets seem to drive a cervicogenic overlap, we may discuss medial branch blocks. We refer when the story suggests a need for neurology input, advanced imaging follow-up, or surgical consideration.

Which nerves are involved?

Most often the greater occipital nerve, sometimes the lesser occipital nerve, and occasionally both. Pain tracks the nerve territory up the back of the scalp.

What does an occipital nerve block do?

Local anesthetic (sometimes with steroid) is placed near the nerve. Relief during the anesthetic window supports the diagnosis and can reduce pain for a stretch of time.

When do you order imaging or refer?

When pain is new and severe, progressive, tied to trauma, or paired with neurologic red flags. We also refer when the pattern does not fit or when another specialty is the better next step.