Occipital Neuralgia (Headache)

Medically Reviewed on 11/23/2022

What is an occipital neuralgia headache?

Woman holding the back of her neck.
Occipital neuralgia causes pain along the upper neck and the back of the head.

Occipital neuralgia is a form of headache that causes pain along the upper neck and back of the head. The pain is in the distribution of the nerves known as occipital nerves (sensory nerves that run from the upper part of the neck to the back of the head).

The pain of an occipital neuralgia headache can be;

  • throbbing,
  • aching,
  • burning, or
  • can feel sharp and stabbing.

Sometimes, this condition is referred to as occipital neuritis, suggesting there are some associated inflammatory changes that have affected the occipital nerves.

Occipital neuralgia is not serious. This type of headache does not lead to other neurological conditions or nerve problems, even if left untreated.

What does occipital neuralgia feel like?

Pain along the neck where it meets the skull, as well as pain along the back of the head and neck people with occipital neuralgia usually have.

  • The pain might be one-sided or bilateral (located on both sides of the head).
  • The pain might be sharp or stabbing or feel like an electric shock along the nerve.
  • Sometimes the pain is a dull aching or throbbing.
  • The pain often can travel along the side of the head, sometimes as far forward as the forehead.
  • There can be some symptoms that are frequently seen with migraine headaches or other headaches, including sensitivity to light or sound, or scalp tenderness.
  • People with an occipital neuralgia headache may have increased pain when moving their necks.

If the pain caused by occipital neuralgia travels along the side of the head to the face, it might initially be mistaken for a condition known as trigeminal neuralgia. However, physical examination and assessment of the history of the pain should reveal important differences that will help lead to the correct diagnosis.


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What triggers an occipital neuralgia headache?

The cause of occipital neuralgia is poorly understood. It is thought to occur when the occipital nerves become irritated or inflamed. There can be many different causes and triggers of this nerve irritation, including;

  • whiplash or another injury to the neck,
  • injury to the back of the head,
  • muscle spasm or recurrent muscle tightness,
  • arthritis of the cervical spine, or
  • other structural changes to the upper cervical spine.

Infrequent causes of this type of headache can include;

  • diabetes,
  • infection, or
  • inflammation of different blood vessels.

How do you get rid of occipital neuralgia headache?

If the pain persists, daily medications to help calm the nerve may be used. These medications can include

  • anti-seizure medications or
  • antidepressants.
  • Occipital nerve blocks using an injection of a local anesthetic and a steroid agent may be performed. These often are quite successful in relieving chronic pain for several weeks or months at a time.

Conservative therapy

When combined with physical therapy, massage, daily stretching, strengthening exercises, and other conservative measures, people with this type of headache can often do well for many weeks or months at a time. Some people find that a one-time course of physical therapy or a single nerve block alleviates their pain completely.

Invasive therapy

If the pain from an occipital neuralgia headache fails to respond to conservative treatment options, there are several more invasive therapies that have been shown to be successful. These include:

  • Rhizotomy (destroying the nerve root to eliminate the pain)
  • Neurolysis (applying heat, freezing the nerve, or applying different chemicals to the nerve to block the transmission through the nerve)
  • Implanting an occipital nerve stimulator (similar to a TENS unit).


Decompression surgery to open the area around the nerve also can be performed.

Symptomatic treatment options

Although a specific cure for occipital neuralgia does not exist, there are many effective symptomatic treatment options.

Natural therapies

The medical treatment for occipital neuralgia can vary. Often, conservative treatments are used as first-line options, including;

  • heat,
  • massage,
  • rest,
  • physical therapy,
  • muscle relaxants, and
  • anti-inflammatory medications.

What procedures and tests diagnose an occipital neuralgia headache?

  • There is no test to specifically diagnose or confirm occipital neuralgia.
  • The diagnosis is made on physical examination findings such as a marked tenderness to pressure along the occipital nerve; palpation of this region often will reproduce or worsen the pain that the patient is experiencing.
  • If the patient has tenderness over the distribution of the greater occipital nerve is important in making this diagnosis. There may be some associated muscle tightness or spasms in the neck region.
  • Some doctors perform a nerve block using a local anesthetic to see if this will eliminate or relieve the pain, helping to confirm the diagnosis.
    • X-rays of the neck, CT scan, or MRI scan may be ordered if there is a concern that some underlying problem is causing the symptoms.

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Will a ketogenic (keto) diet help reduce inflammation and pain from an occipital neuralgia headache?

The ketogenic diet is a high-fat diet that drastically restricts carbohydrates. It produces a reaction in the body that is similar to fasting. The low-carb, high-fat keto diet causes the metabolic state known as ketosis, in which substances known as ketones or ketone bodies accumulate in the blood. These are the same substances that accumulate during ketoacidosis (a medical emergency) in people with type 1 diabetes.

A ketogenic diet has been shown to be effective in treating seizure disorders that have not responded to two different antiseizure medications. While this treatment is most often used in children, some adults with seizure disorders may also be helped by a ketogenic diet. Recent studies have explored the ability of ketogenic diets to reduce inflammation and pain from occipital neuralgia.

A ketogenic diet is typically not recommended for weight control because it is not superior to other more standard weight management plans and may be associated with health risks, including nutritional deficiencies.

Most ketogenic diets permit foods high in saturated fat, including;

  • processed meats,
  • fatty cuts of meat, for example;
  • red meat, 
  • lard, and 
  • butter.

Usually, a ketogenic diet also includes unsaturated fats like;

  • oily fish, 
  • nuts, 
  • seeds, and 
  • plant oils.

Can Occipital neuralgia be cured?

  • For most people, conservative therapy or occipital nerve blocks are quite effective in relieving their pain.
  • For others, more invasive therapies can be quite successful.
  • As with many other conditions, the response to treatments can vary widely.
  • Occipital neuralgia is not serious. This type of headache does not lead to other neurological conditions or nerve problems, even if left untreated.

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Medically Reviewed on 11/23/2022
National Institute of Neurological Disorders and Stroke. Occiptal Neuralgia Information Page.

American Association of Neurological Surgeons. "Occiptal Neuralgia." Updated: Feb 2013.

Masino, SA, et al. Ketogenic Diets and Pain. J Child Neurol. 2013 Aug;28(8): 993-1001.