Posterior Headaches

Unraveling the Knot: Understanding Posterior Headaches and Their Complex Origins

Headaches are a common affliction, but when the pain is concentrated in the posterior region of the head, it presents a unique set of challenges. This article explores the intricacies of posterior headaches, shedding light on their epidemiology, various types, potential causes, symptoms, diagnostic steps, and the array of treatment options available to provide relief.

Posterior headaches, while less common than general headaches, still impact a significant portion of the population. The prevalence varies among different types of headaches, with conditions like occipital neuralgia and tension-type headaches frequently contributing to posterior head pain.

Types of Posterior Headaches
  1. Occipital Neuralgia: Characterized by sharp, shooting pains stemming from the occipital nerves at the base of the skull.
  2. Tension-Type Headaches: Often presenting as a constant, dull ache, these headaches can affect the entire head, including the posterior region.
  3. Cervicogenic Headaches: Originating from issues in the neck, cervicogenic headaches commonly manifest as posterior head pain. Cervicogenic headaches are a type of headache that originates from the cervical spine, which is the neck region. Unlike other primary headaches such as migraines or tension-type headaches, cervicogenic headaches are secondary, meaning they are caused by another underlying issue in the neck. These headaches typically result from abnormalities or disorders in the cervical vertebrae, nerves, or soft tissues.

The causes of posterior headaches are diverse and may include musculoskeletal issues, nerve impingements, inflammation, or underlying medical conditions. Identifying the root cause is crucial for effective management.

  1. Location of Pain: Posterior headaches primarily manifest at the back of the head, near the neck or upper cervical spine.
  2. Quality of Pain: Pain may range from sharp and stabbing (occipital neuralgia) to a constant, dull ache (tension-type headaches).
  3. Accompanying Symptoms: These may include neck stiffness, visual disturbances, or sensitivity to light and sound.
Steps of Diagnosing the Cause
  1. Thorough Medical History: Detailed questioning about the nature, frequency, and triggers of headaches.
  2. Physical Examination: Evaluation of the head, neck, and neurological systems.
  3. Imaging Studies: CT scans or MRIs may be employed to rule out structural issues in the head and neck.
Treatment Options
  1. Medications: Pain relievers, muscle relaxants, or medications targeting nerve pain may be prescribed depending on the type and severity of the headache.
  2. Physical Therapy: Exercises and stretches to alleviate tension and improve neck and shoulder strength.
  3. Nerve Blocks: Local anesthetic injections targeting specific nerves to relieve pain.
  4. Lifestyle Modifications: Stress management, posture improvement, and regular exercise can contribute to headache prevention.
Interventional Modalities
  1. Occipital Nerve Blocks: Injections targeting the occipital nerves for relief in occipital neuralgia.
  2. Botox Injections: Botulinum toxin injections may be considered for chronic migraine relief.
  3. Facet Blocks and Radiofrequency Ablation: A highly successful treatment for facet medicated posterior headaches or cervicocranial syndromes.

Posterior headaches present a complex tapestry of causes and symptoms, requiring a comprehensive approach to diagnosis and management. By understanding the specific characteristics and triggers of these headaches, healthcare professionals can tailor treatment plans to address the individual needs of patients, offering hope for effective relief and improved quality of life.


  1. Marmura, M. J., Silberstein, S. D., Schwedt, T. J. (2015). The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies.
  2. Bogduk, N. (2014). On the Definitions and Physiology of Headache. Headache, 54(6), 1210–1221.

Further Reading:

  1. Goadsby, P. J., Raskin, N. H. (Eds.). (2013). Headache (Vol. 33). Elsevier.
  2. Silberstein, S. D., Lipton, R. B., Dodick, D. W. (Eds.). (2019). Wolff’s Headache and Other Head Pain (9th ed.). Oxford University Press.
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