Patients describe it as an electric shock. It starts at the base of the skull and shoots forward across the scalp, sometimes behind one eye. Brushing the hair hurts. Lying on a pillow hurts. And it is very often being treated as a migraine. At Remix Medical in Houston, our pain physicians diagnose occipital neuralgia with a targeted nerve block that is both a test and a treatment.
What is Occipital Neuralgia?
Occipital neuralgia is a distinct headache disorder caused by irritation, compression, or injury of the greater and lesser occipital nerves. These nerves arise from the upper cervical spine and travel up the back of the head to supply sensation to the scalp.
When they are inflamed, they misfire. The result is paroxysmal, lancinating pain in the distribution of the nerve — not the throbbing, whole-head quality of a true migraine.
The distinction matters because the treatments differ entirely.
Common Causes of Occipital Neuralgia
1. Cervical Spine Degeneration
Arthritis at the C1–C3 levels irritates the nerve roots from which the occipital nerves arise.
2. Muscle Tension and Entrapment
The greater occipital nerve pierces the suboccipital muscles. Chronic tension, poor posture, and prolonged screen work can compress it there.
3. Trauma
Whiplash and direct blows to the back of the head can injure the nerve or the surrounding tissue.
4. Prior Surgery or Scar Tissue
Scarring near the nerve's course can tether it.
5. Systemic Contributors
Diabetes, gout, and inflammatory conditions can each affect peripheral nerve health, including these.
In many patients no single cause is identified, and the condition is treated on the strength of its presentation.
Symptoms of Occipital Neuralgia
- Sharp, stabbing, or electric pain starting at the base of the skull
- Pain radiating over the scalp toward the top of the head, occasionally behind the eye
- Usually one-sided, though it can affect both sides
- Scalp tenderness — hair brushing, hats, and pillows are uncomfortable
- Pain triggered by neck movement or extension
- Light sensitivity in some patients, which is one reason it is confused with migraine
How Remix Medical Can Help
Diagnosis rests on the history, the distribution of pain, and reproducible tenderness over the occipital nerve. Imaging is used to evaluate the cervical spine, not to make the diagnosis itself.
An occipital nerve block serves as the confirmatory step. Local anesthetic and steroid are deposited around the nerve. Rapid relief of the familiar pain both confirms the diagnosis and often provides weeks to months of benefit.
Our treatment options include:
- Greater and lesser occipital nerve blocks
- Cervical medial branch blocks where upper cervical facet joints are contributing
- Radiofrequency ablation for patients with reproducible but short-lived block relief
- Medication management, including agents for neuropathic pain
- Physical therapy and posture correction for entrapment-driven cases
- Coordination with our chiropractic team where cervical mechanics are a factor
| Approach | What it involves |
|---|---|
| Posture + physical therapy | Reduces strain on the occipital nerves |
| Medications | Nerve-pain agents and anti-inflammatories |
| Occipital nerve blocks | Both diagnostic and often durably therapeutic |
| Radiofrequency or stimulation | For pain that recurs despite blocks |
Relief from Occipital Neuralgia at Remix Medical
If migraine medication has never quite worked, it may be because this was never a migraine.