From the Cavanaugh blog
Why Am I Getting Sharp Pain at the Back of My Head?
By Dr. Matthew Cavanaugh, Cavanaugh Chiropractic, Lafayette, Louisiana
When patients come into my office complaining of a severe headache, one of the first things I hear is, “Doc, I’ve got a migraine.”
And sometimes they do. But I’ve noticed that people tend to call just about any really bad headache a migraine, whether it actually is one or not.
The truth is, headaches can have a lot of different causes. Some come from the neck, some involve muscle tension, and others may be related to irritated nerves.
One condition that often surprises patients is occipital neuralgia, which can cause sharp, shooting pain that starts near the base of the skull and travels up the back of the head.
If you’ve ever experienced that kind of pain, you know how uncomfortable, and sometimes frightening, it can be.
Why Does the Back of My Head Hurt?
There are several nerves and muscles around the base of your skull. Among them are the occipital nerves, which provide sensation to much of the back and top of your head.
When these nerves become irritated, they can produce some pretty intense symptoms.
Patients may describe the pain as:
- Sharp, shooting, or stabbing
- An electric shock traveling up the back of the head
- Burning or tingling along the scalp
- Tenderness around the base of the skull
- Pain when brushing their hair or resting their head against a pillow
The pain may occur on one side or both sides of the head. Sometimes it comes in sudden bursts lasting seconds or minutes. Other times, patients experience lingering tenderness or aching between episodes.
This pattern can suggest occipital neuralgia, but it doesn’t automatically mean that’s what you have. Several other conditions can cause similar symptoms.
Is It a Migraine, a Tension Headache, or Occipital Neuralgia?
One thing I’ve learned over the years is that there’s really no such thing as a “regular headache.”
What’s normal for one patient may be completely different for another. Someone who frequently experiences migraines might consider those their usual headaches, while someone else may rarely experience head pain at all.
That’s why I pay attention to where the pain starts, where it travels, and how the patient describes it.
Occipital neuralgia often causes sharp, shooting, or electric-like pain along the path of the occipital nerves. The scalp may also become unusually sensitive to touch.
Cervicogenic headaches originate from structures in the neck. Patients may notice pain that begins in the neck or base of the skull and travels toward the forehead or behind an eye. Certain neck movements or positions may aggravate their symptoms.
Tension-type headaches generally feel more like pressure, tightness, or a dull ache. Some patients describe a band squeezing around their head.
Migraines are a neurological headache disorder that can cause moderate to severe pain, often with nausea or sensitivity to light and sound. Migraine pain can also occur at the back of the head, so location alone doesn’t rule it out.
These conditions can overlap, and occasionally a patient may have more than one headache disorder.
The important thing is figuring out what’s actually causing the symptoms rather than assuming every severe headache is a migraine.
What Do I Look for During an Examination?
When someone comes into our Lafayette chiropractic office with pain at the back of their head, I start by listening to how they describe it.
Where does it begin? Does it travel? Is it sharp, dull, burning, or shooting? Are certain movements or positions making it worse?
From there, I examine their neck and the area around the base of the skull.
I routinely palpate the muscles beneath the skull because they can become tight and tender for several reasons. I also evaluate cervical range of motion, muscle tenderness, and whether gentle pressure or tapping along the occipital nerves reproduces the patient’s symptoms. Neurological findings are important as well.
One thing I’ve noticed with patients experiencing particularly intense occipital neuralgia is just how sensitive the area can become.
Sometimes they’re almost afraid to let me touch the back of their head because they’re anticipating how much it’s going to hurt.
That degree of sensitivity can be an important clue, although it isn’t enough by itself to establish a diagnosis.
The goal of the examination is to determine whether the symptoms are consistent with occipital nerve irritation, another type of headache, or something that requires additional medical evaluation.
A Patient Who Thought Something Was Seriously Wrong
I remember a longtime patient who experienced such severe pain at the back of her head that she went to the hospital.
She didn’t know what was happening, and understandably, she was concerned.
At the hospital, she was diagnosed with occipital neuralgia. Afterward, she came to our office wondering whether chiropractic care might help.
She was hurting badly and was nervous about having her neck treated.
After examining her, we discussed her options and proceeded with a cervical adjustment.
She later told me that her pain actually intensified for several hours following treatment. But when she went to sleep that night and woke up the next morning, the pain was gone.
A month or two later, she experienced another episode, although it was less severe. After a second treatment, she again reported that her symptoms improved by the following morning. We later received word through a family member that she continued to do well without further reported episodes.
Now, I don’t share that story to suggest every patient with occipital neuralgia will respond that quickly. They won’t. Some cases improve quickly, others take longer, and some don’t respond to chiropractic treatment.
But it’s an experience that has stayed with me because of how frightened she initially was and how much relief she ultimately experienced.
Can Chiropractic Care Help Occipital Neuralgia?
Sometimes, yes. But I think it’s important to be realistic about treatment.
When I suspect occipital neuralgia and the examination suggests conservative care is appropriate, I may recommend a short trial of treatment.
Depending on the patient’s findings and tolerance, that might include cervical adjustments, gentle muscle work, or dry needling.
Not everybody responds to the same treatment, and I don’t believe in continuing something indefinitely if it isn’t helping.
Generally, if we’re not seeing meaningful improvement after a couple of weeks, I’ll discuss other options with the patient. That might include a referral to a medical doctor, such as a neurologist, for further evaluation and treatment. Some patients may also be interested in acupuncture as another conservative approach.
Chiropractic care isn’t a guaranteed solution for occipital neuralgia, and the research supporting specific chiropractic treatments for this condition is limited. Treatment decisions should be based on the individual patient’s examination, symptoms, and response.
My goal isn’t to convince someone they need to keep coming back. It’s to help them find an approach that works.
What Can You Do at Home?
I don’t give every patient the same list of things to do or avoid because people respond differently.
Some find relief with gentle heat or a cold pack. Others notice that changing their sleeping position, avoiding prolonged pressure against the back of their head, or taking breaks from uncomfortable neck positions makes a difference.
I encourage patients to pay attention to what helps and what aggravates their symptoms, without forcing movements or activities that increase their pain.
I have a saying in my office:
“If riding a pink unicorn is going to make you feel better, I’ll help you find a pink unicorn.”
Obviously, I’m joking. But the point is that I’m interested in helping patients find relief, even if the approach isn’t necessarily the same for everybody.
As long as it’s reasonable and safe, I’m open to discussing it.
When Should You Be Concerned About a Headache?
Most headaches aren’t emergencies, but there are certain symptoms I take very seriously.
If someone comes into my office with a severe headache accompanied by weakness, confusion, significant dizziness, vision changes, or other neurological symptoms, I’m concerned about something beyond a routine headache.
A sudden, extremely severe headache that reaches its worst intensity almost immediately is another warning sign, even if there aren’t other symptoms.
I also pay attention to blood pressure. If someone has a history of dangerously high blood pressure, or describes symptoms like pounding, pulsing, or intense pressure in their head, I’ll check their blood pressure. Sometimes patients use different words to describe those sensations, so it’s important to listen carefully to what they’re telling me.
High blood pressure often causes no symptoms at all. However, severely elevated blood pressure accompanied by concerning symptoms can signal a medical emergency.
Other warning signs include fever with a stiff neck, new difficulty speaking or walking, sudden loss of vision, or a new severe headache following an injury.
If I suspect something serious, I’m not going to try to treat it as a routine headache. I’m going to recommend immediate medical evaluation, and when emergency symptoms are present, that means calling 911.
No amount of chiropractic treatment should delay appropriate emergency care.
Don’t Assume Every Severe Headache Is a Migraine
If there’s one thing I want patients to understand, it’s that the word headache covers a lot of different conditions.
Sharp pain at the back of your head might involve an irritated occipital nerve, a problem originating in your neck, or something entirely different.
And while the way you describe your symptoms can provide valuable clues, it takes a proper history and examination to narrow down the cause.
At Cavanaugh Chiropractic in Lafayette, Louisiana, we evaluate neck pain and headaches to help determine whether conservative chiropractic treatment may be appropriate or whether further medical evaluation is needed.
If you’re dealing with persistent pain at the back of your head, give us a call. We’ll take a look, talk through what’s going on, and help you figure out a reasonable next step.
Call Cavanaugh at (337) 984-5852.
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