Sharp, electric pain at the back of your head.
Occipital neuralgia causes sudden, shooting pain that runs from the base of the skull up over the scalp — often mistaken for a migraine or tension headache, but driven by an entirely different mechanism. Identifying it correctly changes everything about how it's treated, and relief can come quickly once the right nerve is targeted.
Your doctor may call this Arnold's neuralgia or C2 neuralgia.
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What occipital neuralgia really is.
Occipital neuralgia is pain caused by irritation or injury to the occipital nerves — the nerves that run from the top of the spinal cord through the scalp. There are two main ones: the greater occipital nerve and the lesser occipital nerve. When either is compressed, inflamed, or damaged, the result is a distinctive pain pattern: sharp, electric shocks that shoot from the base of the skull toward the top or sides of the head, often on one side only.
The condition is frequently confused with migraines or tension headaches because the pain overlaps in location. The key differences are the quality (shooting or electric rather than throbbing) and the scalp tenderness — pressing on the occipital nerve at the back of the skull is typically exquisitely tender, and that finding helps separate occipital neuralgia from other headache types. Common causes include muscle tightness in the neck, prior neck injury, arthritis in the upper cervical spine, or, sometimes, no identifiable trigger at all.
The good news
Occipital neuralgia responds well to targeted treatment. An occipital nerve block — a small injection of local anesthetic near the nerve — can provide prompt relief and also confirms the diagnosis at the same time. For longer-lasting results, additional options are available, including steroid injections or, in some cases, pulsed radiofrequency treatment of the nerve.
Diagnosing with a nerve block
The International Headache Society includes a diagnostic criterion that is unusual in headache medicine: pain relief following a local anesthetic block of the occipital nerve helps confirm the diagnosis. In practice, this means the occipital nerve block is both therapeutic and diagnostic — a positive response to the block is strong evidence that the occipital nerve is the pain generator, and it informs the longer-term treatment plan.
Common signs we treat.
Sharp, electric pain at the back of the head
Sudden, shooting or stabbing pain that starts at the base of the skull and radiates upward — often described as an electric shock running over the scalp.
Scalp tenderness
The scalp directly over the occipital nerves is often exquisitely sensitive to touch — even combing hair or resting your head on a pillow can provoke pain.
Pain spreading toward the scalp
Pain that travels from the back of the head toward the crown, temple, or behind the eye — following the path of the occipital nerve distribution.
From hurting to healed.
We work from the least-invasive options upward, escalating only if you need it. Most patients improve well before surgery is ever discussed.
Diagnose the cause
A physician examines you and, if needed, reviews imaging to pinpoint exactly what's driving the pain.
Calm it down
Targeted physical therapy, activity guidance, and medication to settle the irritation and reduce inflammation.
Image-guided injections
If pain persists, a precisely targeted injection delivered to the source under imaging.
Advanced options
For the few who need more, minimally invasive interventional procedures — with surgery as a last resort.
Treatment is matched to your specific diagnosis at your visit. The options shown reflect NASPAC's general approach and should be confirmed against the practice's verified procedure list.
Still have questions?
Occipital neuralgia is a condition in which the occipital nerves — which run from the top of the spinal cord through the scalp — become irritated or inflamed. This causes shooting, electric pain from the base of the skull up over the head, often on one side. It's a distinct diagnosis from migraine and tension headache, though it can coexist with either.
The main differences are the character of the pain and the scalp tenderness. Occipital neuralgia produces sharp, shooting, or electric pain — not the throbbing, pulsating pain of a migraine. Scalp tenderness over the occipital nerves (at the base of the skull) is characteristic of occipital neuralgia and not typical of migraine. Migraines also usually come with nausea and light sensitivity; occipital neuralgia usually does not. That said, the two conditions can occur together.
An occipital nerve block is a small injection of local anesthetic — sometimes combined with a low-dose steroid — placed near the greater or lesser occipital nerve at the back of the skull. It takes only a few minutes, is done in the office, and can provide significant pain relief. Because a positive response also helps confirm the diagnosis, the block serves two purposes at once. Relief from a single block can last weeks to months.
Common causes include tight or spasming muscles in the upper neck that compress the nerve, arthritis in the upper cervical vertebrae, a prior neck injury (including whiplash), prolonged poor posture with the head forward, or blood vessel compression of the nerve. In some cases no specific cause is found, but the nerve is nonetheless irritated and still responds to targeted treatment.
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