Posterior Headaches Explained: Symptoms, Causes and Treatments

Posterior simply means the back part of something. When we say “posterior headaches,” we are referring to headaches that cause pain at the back of the head—often near the top of the neck or the base of the skull.

While most headaches are felt in the temples or forehead, posterior headaches create a very different experience. These headaches can feel sharp, throbbing, or like a band of pressure pulling from the back of the head. This page will help you understand why they occur, how to recognize the signs, and what treatments may help you find relief.

Understanding Posterior Headaches

Posterior headaches are less common causes of headaches and facial pain syndromes, but they can still affect people of all ages. The pain usually starts in the upper neck or base of the skull and may spread to the sides of the head or behind the eyes. There are multiple reasons why someone might experience posterior head pain, and pinpointing the cause is key to proper treatment.

Types of Posterior Headaches

Several headache types can cause pain at the back of the head. The most common include:

1. Occipital Neuralgia: A nerve-related condition causing sharp, electric shock-like pain that starts at the base of the skull and radiates upward. Learn more from PubMed.
2. Tension-Type Headaches: Often caused by stress, poor posture, or fatigue. The posterior area may feel tight or sore. See more from the Mayo Clinic.
3. Cervicogenic Headaches: These headaches originate in the neck (cervical spine) and radiate toward the back of the head. Learn more from the NIH Clinical Manual.

Causes of Posterior Headaches

The causes of posterior headaches usually involve neck structures or nerves. Common causes include:

• Neck muscle strain or tension due to poor posture or long hours at a desk
• Cervical arthritis or disc degeneration
• Compression or irritation of the occipital nerves
• Trauma or whiplash injuries
• Shingles or viral infections involving the scalp nerves

In rare cases, these headaches may signal more serious issues, such as brain aneurysms or increased intracranial pressure, which require urgent care.

Symptoms of Posterior Headaches

Symptoms may vary depending on the cause. However, many people report the following:

1. Location: Pain focused at the back of the head or base of the skull
2. Type of pain: Dull, achy, stabbing, or electric-shock sensations
3. Other symptoms: Light sensitivity, scalp tenderness, or neck stiffness

Scalp tenderness is especially common in occipital neuralgia, where even touching the hair can feel painful.

How Posterior Headaches Are Diagnosed

To find the root cause of your posterior headache, your provider will begin by gathering information about your symptoms and conducting a physical examination. This helps determine if your pain is nerve-related, muscular, joint-based, or possibly something more serious.

1. History: Your provider will review your headache patterns, past trauma or injury, posture habits, and any associated symptoms like scalp tenderness or vision changes.
2. Physical Exam: They will assess your neck mobility, check for tight muscles, palpate the base of the skull for tenderness, and test nerve sensitivity. Many posterior headaches are linked to underlying neck pain and dysfunction.
3. Imaging: If needed, an MRI or CT scan may be ordered to rule out structural causes such as disc degeneration, arthritis, or space-occupying lesions affecting the cervical spine or brain.
4. Diagnostic Injections: One of the most useful tools in identifying the exact pain generator is the use of ultrasound-guided injections:
   • Greater Occipital Nerve Block: Helps determine if the main nerve supplying the back of the head is the pain source.
   • Lesser Occipital Nerve Block: Targets a smaller nerve that may cause pain in the side of the upper neck and behind the ear. These are often performed together during an occipital nerve evaluation.
   • Cervical Medial Branch Block: Used to test whether arthritic joints in the neck (cervical facet joints) are referring pain to the back of the head. If these blocks provide relief, it confirms the diagnosis and can guide long-term treatment like radiofrequency ablation (RFA).

When these blocks result in significant short-term pain relief, it helps isolate the precise nerve or joint responsible. This allows your provider to develop a more targeted and effective treatment plan.

When to Worry: Red Flags

Posterior headaches are often benign, but seek emergency care if you experience:

• Sudden, thunderclap headache
• Vision changes, slurred speech, or confusion
• Loss of balance, fainting, or seizures
• Fever with neck stiffness (possible meningitis)

These may be signs of life-threatening conditions and should never be ignored.

Treatment Options

Once the cause of your posterior headaches is determined, your provider can tailor a treatment plan focused on both short-term relief and long-term prevention. Many patients benefit from a combination of therapies that address muscular, joint, or nerve-related triggers.

1. Medications: First-line options include anti-inflammatories (NSAIDs), muscle relaxants, or nerve-stabilizing medications such as gabapentin or pregabalin. These may help reduce central sensitization and inflammation.
2. Physical Therapy: Targeted physical therapy can improve posture, release neck muscle tension, and support cervical alignment. Your therapist may also incorporate manual therapy and neural mobilization techniques.
3. Trigger Point Injections: Tight bands in neck and scalp muscles (like the trapezius, semispinalis capitis, or splenius) can refer pain to the back of the head. Trigger point injections break these spasms and improve blood flow. Typically performed weekly or biweekly for 3–6 sessions, they are especially helpful in chronic tension-type and cervicogenic headaches.
   [PubMed study]
4. Occipital Nerve Block: A small injection of anesthetic and steroid near the greater and lesser occipital nerves can reduce inflammation and block pain signals. This is often used diagnostically and therapeutically for occipital neuralgia and migraines with posterior onset.
   [PubMed: effectiveness in chronic migraine]
5. Lifestyle Adjustments: Addressing ergonomics, sleep hygiene, and daily stress management are crucial. Your provider may also recommend posture correction strategies and ergonomic evaluations.

Other Emerging or Adjunctive Treatments

• Sphenopalatine Ganglion Block (SPG): Occasionally used for deep migraine-type pain that refers to the posterior skull.
• Stellate Ganglion Block (SGB): May help patients with post-concussion or sympathetic nerve-driven headache syndromes.
• Transcranial Magnetic Stimulation (TMS): Non-invasive brain stimulation approved for migraine; future applications for occipital pain are under study.

Advanced Interventions at SpinePain Solutions

For stubborn or chronic posterior headaches, we offer advanced pain management procedures:

• Targeted neurotoxin therapy for chronic migraine*

• Radiofrequency Ablation (RFA): For longer-term relief, pulsed or thermal RFA can be used on the greater occipital nerve or cervical medial branches. Pulsed RFA modulates nerve signaling without destroying the nerve, while continuous thermal RFA ablates the pain fibers directly. Both are minimally invasive and effective for 6–12 months or longer.
  [PubMed: Pulsed RFA for occipital neuralgia]
• Occipital Peripheral Nerve Field Stimulation: In treatment-resistant cases, peripheral nerve stimulation (PNS) of the occipital nerves may be considered. This involves implanting a small device under the skin that sends electrical impulses to block pain signals to the brain. It is typically reserved for patients who fail conservative treatments and blocks.
  [PMC review of occipital nerve stimulation]
• Regenerative medicine for nerve recovery

Why Choose Dr. Amit Sharma?

Dr. Amit Sharma and the team at SpinePain Solutions specialize in accurate diagnosis and cutting-edge, minimally invasive treatments for spine and nerve-related headaches. We aim to reduce pain and restore your quality of life—without long-term reliance on medications.

Find expert care at any of our Long Island locations:

• Commack
• Bay Shore
• Huntington
• Bethpage

Further Reading

• Occipital Neuralgia Review – NIH
• American Migraine Foundation: Occipital Neuralgia
• Merck Manual: Headache in Adults

Frequently Asked Questions