Pounding headache on top of head and back

by Gayi Siphosethu
(Capetown South Africa)

hi am a 23yr old black female and a 3rdyr university student.

I suffer from this constant pain on the top of my head and back right down to my neck and back..i've been to the dr. twice and it was diagnosed as Sinusitus..i've completed treatment but still the headaches haven't gone away

description of the pain:it feel like my brain is breathing,pounding and this pain can last for hours..i also battle to concentrate and i sometimes feel a bit dizzy!

please help!!!!!



Hi Gayi,

It seems a little confusing that you were diagnoses with sinusitus when your pain is at the top of the head and in the neck. The sinuses are in the front of the skull around the eyes.

Believe it or not, I have seen this plenty of times with college and high school (secondary school) students. When you spend a lot of time studying, you usually have your neck flexed forward while you are reading. Eventually this causes spasms in the neck known as cervicogenic headache. When the trapezius muscle is in spasm, it pulls on the scalp muscles and causes a tension type headache.

The "dizziness" is most probably dysequilibrium (a sensation of feeling drunk) caused by the spasms. The nerves in the neck are being affected by this and feeding back to the brainstem, which helps control vertigo.

Go back to the doctor and ask about an anti-spasmotic and going to physical therapy for the neck.

Good luck!
Mary Kay Betz MS RPA-C


Thank you for responding!

hi, thank you I've taken your suggestion and made an appointemnt to see the Dr. midweek..will let you know how it goes *hope it helps..this is affecting my concentration a lot during lectures*

regards..Gayi S

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Daily Occipital Headaches

by Robin J.
(Lee's Summit, MO)

I am a 31 y/o female with daily occipital headaches times 6 months. I was first diagnosed with tension headaches by my primary care physician. The pain started out as bilateral occipital pain and progressed to generalized severe daily headaches.

Since then I have developed ringing in my ears, nausea, muscle tenderness in my legs, orthostatic hypotension (which resulted in one episode of syncope) and tingling in my hands, feet, and lips. My headache pain is made worse with increased activity. Due to that and the increased heart rate and dizziness upon standing, I have not been able to work for almost two months.

I have seen 2 neurologists (neither were headache specialists), a pain management doctor, and an endocrinologist. I have been diagnosed with occipital neuralgia and given 2 occipital nerve blocks which did not work.

I have had an MRI w/ and w/o contrast which were both negative. I tried Amitriptyline and Voltaren, neither of which helped. I am now on Topamax which has brought my pain down to 5/10 and restricted my pain to the occipital region.

I do have a history of migraines but these headaches do not feel like my previous migraines and they do not respond to my migraine medicines. I also went 2 weeks without any medications per the directions of the neurologist in order to rule out rebound headaches. I do not currently take any OTC medications.

You mentioned in a previous question that some occipital pain can be from a vascular problem. I have not had any doctors mention this possibility. Is a MRA required to see this? Can you please elaborate on this? I have always experienced mild orthostatic hypotension but it has been much worse over the last couple of months. Could this be related to my headaches?
Can you recommend a headache specialist in my area?

I am a mother of two and an ER nurse. I would really like to get back to my life. Any advice you can give me would be very helpful.

Thank you,


Hi Robin,

I am glad you got to see neurologists but I am a bit surprised that with a new onset of occipital headache that no one has ordered the MRA. Although an MRI can show a moderate to large aneurysm, small ones can be missed. Your instincts are correct, especially with worsening hypotension, to get an MRA and view not only the Circle of Willis but also the vertebral/basilar arteries and rule out aneurysm.

External MRA of carotids or carotid dopplers should also be performed and with worsening hyptotension you need a cardiac workup. The neurologist would not do this but it should be directed by your PMD or a cardiologist. If the MRA and dopplers are normal, then I would also request a tilt table test to r/o neurocardiogenic syncope. You would be surprised how many of my female migraineurs have this!

Additionally, I do not see an EEG. With a new episode of syncope this is pretty much standard in our clinic.

Our standard blood work for a new headache patient includes TSH, thyroid panel, ESR, ANA, Vitamin B12, methylmelonic acid, CBC with diff, and Vitamin D levels.

Lets say all tests come back normal..if the topamax is working, the dose can be increased a bit and you might respond well to low dose steroid for a few weeks.

If repeated nerve blocks fail and you do indeed have occipital neuralgia that is chronic and refractory, occipital stimulators are showing excellent promise for this and other headache syndromes.

As far as headache specialists are concerned, near you there is only one listed for Kansas City:

Jennifer Bickel, MD
Univ of Kansas

There is also a headache center in St Louis:

Dr. Robert Ryan and his associates,
Ryan Headache Center

Good luck!
Mary Kay Betz MS RPA-C

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Pain In Back Of Head

by Lisa H.
(Danville, AL USA)

I have been having a pain in the upper left side of my head for over six months. I went to the doctor and they had me get two trigger shots. That has not helped my pain.

I can not sleep on the spot and if I lay on the left side, the pain goes down my head to my neck. It is unbearable and no one seems to be able to help me. They keep giving me medicines and that does not work either.



Hi Lisa,

Believe it or not I hear the complaint of "pain in back of head" almost everyday.

The cause of headache and head pain can be from a variety of reasons, but one of the most common is spasming of neck muscles which radiates up to the side of the head. Most often this is a type of tension type headache. You don't mention what medications you have been on, but I hope you have tried anti-spasmotics.

Why those? Because if you have had trigger point injections, then your doctor does believe it is spasming.

I will assume at this point you have had a medical work up including blood work to rule out any vitamin deficiency symptoms and either an MRI or CT of the brain in addition to carotid dopplers to look at the neck arteries. If not you might want to talk to your doctor about testing.

OK, if you have tried the injections and medications, now what? Here are some options you can try:

  • low dose amitriptyline for spasming
  • Skelaxin during the day
  • proper neck support when sleeping (no feather pillows!)
  • physical therapy
  • moist heat to the area 2-3 times a day
  • a TENS unit

A TENS unit might be quite helpful. This is something the physical therapist can try out for you and if it works, your doctor can order one. Most insurances cover part or all of the cost. This little unit can be worn on the spasming muscles for one hour, twice a day and really can help.

The key to all this is doing everything all together, not just try meds, then try physical therapy, then try the TENS unit. If you are in severe pain, it may take several weeks to a few months to get it under control.

Once you start feeling better, gentle exercise will help keep the "pain in back of head" from coming back again.

Good luck!
Mary Kay Betz MS RPA-C

P.S...no cold packs! This only makes spasms worse.


It was such a relief to read this post, I am currently going through something very similar.

31 yr old female...occipital headaches, turned into daily chronic headaches, no energy want to sleep all the time. Spots in vision among many other things. I have had a CT that came back normal, seeing a neuro on Tuesday of next week. I'm going to request the mri w and w/o contrast as well as the mra w and w/out contrast. I'm also going to request the other bloodwork. I have had cbc, tsh, cmp, and many other tests done. I'm sick and tired of being sick and tired. I want some answers.

I have not yet had the fainting spells, although everything else is pretty much the same. I did have tilt table testing done many years ago and it came back positive for the low blood pressure syncope and they told me to start eating more salt and drinking more water.

Have had 3 ekgs and a 24 holter monitor that came back good recently. I don't know where to go from here, but I'm nervous and anxious everyday.

Taking fish oil supplements, prenaplus for a multivitamin, clonazepam .5 mg 2 x a day and ibuprofen. I was just prescribed prevacid for gerd and metamucil, z pack for sinuses with mucinex d. Haven't started taking the recently perscribed yet. Any suggestions....sensitive to fluorescent lights, Sharp stabbing pains in occipital region back of head sometimes shoots to behind the eyes and ear, dull ache in front of head face and ears. Ringing in ears occasionally, feel off balance sometimes.

Thanks, Jennifer

Southeast MI


Hi Jennifer,

Thanks for the comments..one thing I noticed is the mucinex-D. You might want to stop that as chronic use of it can cause light-headedness and make anxiety worse. The "D" component is pseudofed and unless you have an acute sinus infection you really don't need it.

Good luck
Mary Kay

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