Occipital headache is a type of headache that occurs in the back of the head, specifically at the base of the skull. It may be the cause of your headaches and neck pain.
If you have a history of migraine, sometimes a headache in this area will provoke a migraine. The pain is usually a dull throbbing type of pain and if this occurs then it is a type of tension headache.
If the pain in the back of the head is accompanied by neck pain then occipital headaches are actually a form of cervicogenic headache. Additional causes include occipital neuralgia which is an inflammation of the nerves just under the skin at the back of the skull.
There are a few other causes that I should mention. If the headaches are associated with dizziness then a vascular cause may be the problem. There are several arteries that run up the back of the neck, and if they are compromised for any reason (blockage, loss of tone) then the lack of oxygen to that area causes these symptoms.
Diagnosing Occipital Headache
First of all, if your provider deems it necessary, you will have an MRI of the brain to rule out some of the things I mentioned above. This is more specific than a CT of the brain.
We will also order carotid dopplers and a transcranial doppler (TCD) which looks at the arteries at the back of the skull. These are the vertebral arteries and the basilar artery. 90% of the blood to the brain flows throught the carotids and 10% flows through those at the back of hte brain. Lack of blood to this area results in lack of oxygen, head pain and blurry vision.
If all of these tests come back negative, then we are left with pain originating from musculoskelatal issues.
Treatment of Occipital Headache
Treatment is fairly straight forward. Most people respond to a short dose of oral steroid (one week) or occipital nerve blocks for neuralgia. Additionally, many of my patients respond well to trigger point injections to relieve the spasms in the neck. See the picture to the right? The black dots are trigger points. The red areas are where the pain occurs as this is where the muscle attachs to the skull. Chronic spasming causes pain in this area!
Many times, with severe cases, we do trigger point injections once a month for 4-6 months. Muscles have memory and have to be retrained. These injections usually combine a small amount of steroid mixed with a numbing agent such as lidocaine. This helps calm down the muscular inflammation and breaks up the spasming.
If the headaches are more cervicogenic in origin, then an anti-spasmotic such as Elavil or Flexeril will help.
Good neck support at night is important to prevent these headaches. I recommend and personally use the the Chiroflow pillow which is simply
the best I have ever seen.
If the headache is vascular in origin, sometimes a drug such as Verapamil will help open things up so to speak and allow more blood flow to the area.
Finally, physical therapy for the neck should be combined with medication. PT can really help you heal and there is even a special type for headache called craniosacral therapy. Read more about
different types of headaches if occiptal headache doesn't sound like you.