Piercing Headache

Occipital Neuralgia is a painful condition in which the occipital nerve(s), that travel from the base of the back of the skull up over the top of the head become injured or inflamed. This causes sharp headaches in the back of the head that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head and even piercing behind the eyes.



Symptoms of occipital neuralgia include continuous or intermitent shooting pain, constant aching, burning or throbbing.  The pain centers on the back of head and scalp to the top of the head and sometimes behind the eye.   Triggers include pressure such as laying the head on a pillow or even brushing the hair. The pain is often described as migraine-like because of the severity and some patients may also experience symptoms common to migraines or cluster headaches.


Occipital neuralgia starts as a result of the pinched or irritated greater and/or lesser occipital nerve from injury, muscle tightness or after surgery.  Although any of the following may be causes of occipital neuralgia, many cases can be attributed to other types of chronic neck tension or commonly for unknown reasons.

  • – Osteoarthritis of the upper cervical spine
  • – Trauma to the greater and/or lesser occipital nerves
  • – Compression of the C2 and/or C3 nerve roots from osteoarthritis
  • – Cervical disc disease
  • – Tumors affecting the C2 and C3 nerve roots
  • – Gout
  • – Diabetes
  • – Blood vessel inflammation
  • – Infection

Non Surgical Treatments

  • – Stretching:  When muscles spasm from nerve pain gentle stretching or massage of the muscle can reduce pain.
  • – Heat: Heat works to relax the muscle and increase blood flow which can lessen pain.  Alternate heat with ice to see which you respond best to.
  • – Physical therapy or massage therapy.
  • – Medications:
  • – Anti-inflammatory medications like ibuprofen or aleve;
  • – Muscle relaxants like flexeril; and
  • – Anticonvulsant medications like neurontin target pain generation in the nerve.
  • – Percutaneous nerve blocks with numbing injections that can be used both to diagnose and treat occipital neuralgia.


  • – Occipital Nerve Stimulation:  Minimally invasive surgically placed electrodes under the skin crossing the occipital nerves. The procedure provides pain relief similar to a spinal cord stimulation with the same types of devices. Use of occipital nerve stimulation is an off-label indication for an FDA-approved device.
  • – C2 Ganglionectomy– This treatment involves the disruption of the second and in certain indications the third cervical sensory dorsal root ganglion. Acar et al (2008) studied the benefits, noting a 95% immediate relief with 60% of patients maintaining relief beyond one year.

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