What is Occipital Neuralgia?

Occipital Neuralgia Treatment

Sufferers of Occipital Neuralgia present with unilateral head and neck pain described as; piercing, throbbing, electric-shock like or aching pain. Occipital neuralgia pain is experienced in the upper neck, back of the head or behind the ears. Occasionally, the pain of occipital neuralgia affects the forehead or the scalp. These areas correlate with the distributions of the greater and lesser occipital nerves.

Other occipital neuralgia symptoms can include:

Pain behind the eyes
Visual impairments
Tinnitus
Nausea

Attacks generally last anywhere from a few seconds to several minutes [1].

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Understanding your Headache

The Role of the Occipital Nerve

The primary role of the occipital nerve is to run sensory information (such as pain messages) from the back of the head to the brain. Therefore, all sensory information from the back of your head and neck travels through the occipital nerve.

Sufferers of occipital neuralgia are often very physically sensitive and report that very light stimuli—such as lightly touching the back of the neck, can cause debilitating attacks and intense pain. This could be due to the connection between the occipital nerve and the brainstem, as it plays a crucial role in transmitting and processing sensory information to the brain.

Anatomy of the Occipital Nerve

There are three nerves that group to form the Occipital Nerve, and they originate between the 2nd and 3rd cervical vertebrae. The Greater Occipital Nerve innervates the semispinalis capitis muscle, and also the scalp. The rest of the scalp and the area behind your ears are innervated by the Lesser Occipital Nerve. The C2/3 facet joints, the area below your scalp and semispinalis capitis are innervated by the Least Occipital Nerve [1].

All you need to know about Occipital Neuralgia

Occipital neuralgia is typically caused by a disruption in the normal function of the occipital nerves, which can stem from a variety of underlying conditions. Given that these nerves extend across a wide area, the potential causes are equally broad.

Common triggers include nerve compression (a pinched nerve), trauma from accidents or surgeries, and inflammatory conditions. Diseases such as multiple sclerosis, which damage the protective myelin sheath of nerves, have also been linked to occipital neuralgia. Additionally, conditions like rheumatoid arthritis can contribute to occipital neuralgia by causing joint inflammation and structural changes in the cervical spine, potentially irritating the occipital nerves.

What are the possible causes of irritation?

The following are the reported ‘known’ causes of occipital neuralgia [2]:

Vascular

Aberrant branches of the posterior inferior cerebellar artery irritating the C1/2 nerve roots
A cervical level arteriovenous dural fistula
Bulbocervical cavernomas bleeding
Cervical intramedullary cavernous hemangioma
Giant cell arteritis
Fenestrated vertebral artery pressing on C1/C2 nerve roots
Aberrant course of the vertebral artery

Neurogenic

Schwannoma in the area of the craniocervical junction: schwannoma of occipital nerve
C2 myelitis
Multiple sclerosis

Osteogenic

C1/C2 arthrosis, atlantodental sclerosis
Hypermobile C1 posterior arch
Cervical osteochondroma
Osteolytic lesion of the cranium
Exuberant callus formation after C1/C2 fracture

Muscular

Muscle tightness or dysfunction in the neck, particularly in the suboccipital muscles, can contribute to occipital neuralgia by compressing or irritating the occipital nerves.
Chronic poor posture, stress, or previous neck injuries can lead to excessive muscle tension, intensifying discomfort.
Individuals may also experience severe pain or stiffness in the neck muscles, further exacerbating occipital neuralgia symptoms.

Sensitised Brainstem

In some cases, patients will experience all of the symptoms of Occipital Neuralgia with no apparent cause found under investigation. In these cases, it is possible that a sensitised brainstem is the cause of their symptoms.

This sensitised brainstem will receive typically non-threatening stimuli (such as light touches to the back of the head) as a threat and will respond by causing severe pain along the nerve’s distribution. As the brain continues to recognise this input as a threat, the brainstem becomes even more sensitive, causing the problem to become recurrent. Normal daily tasks such as brushing hair, or scratching your scalp can then become regular triggers, causing debilitating symptoms.

How is Occipital Neuralgia Diagnosed?

It can be difficult to diagnose occipital neuralgia. Given the similarity in symptoms of occipital neuralgia with those of the common migraine headache, it isn’t uncommon for them to be left undiagnosed for long periods of time. One differentiating factor of this painful condition between the two types of headaches are duration of attacks:

Occipital neuralgia episodes are typically short-lived. The sufferer will feel pain that lasts from a few seconds to several minutes, though the sharp pain can persist intermittently throughout the day.
Migraines can last for several hours to multiple days, often accompanied by additional symptoms such as nausea, light sensitivity, and visual disturbances.

Diagnosing occipital neuralgia requires a thorough assessment by a Gold Coast Headache and Migraine Clinic™ practitioner to distinguish it from other headache and neck pain conditions. The process typically involves:

Clinical History: A detailed discussion of your symptoms, including pain location, triggers, and duration.
Physical Examination: A hands-on assessment of your cervical spine, occipital nerves, and surrounding muscles to identify areas of tenderness or sensitivity.
Diagnostic Nerve Blocks: In some cases, a referral for an occipital nerve block may be required. An occipital nerve block is an injection of local anaesthetic used to confirm the occipital neuralgia diagnosis. If the pain subsides temporarily after the injection, occipital neuralgia is likely.
Imaging Tests: While not always necessary, MRI or CT scans may be used to rule out structural causes, such as tumours or cervical spine abnormalities.

Given the overlap in head pain symptoms between occipital neuralgia and other headache disorders, an accurate diagnosis is essential for effective treatment. At Gold Coast Headache and Migraine Clinic™, our approach includes a comprehensive assessment to determine whether brainstem sensitivity or cervical spine dysfunction is contributing to the condition.

Organise Your Initial Assessment

About The Assessment Stage

What To Expect During The Assessment

1. Comprehensive and in-depth examination

We will perform a thorough and in-depth examination to identify all of the factors that may be related to your headaches and migraines. We will focus particularly on your upper cervical spine in our assessment.

2. Ligamental stability and vertebral arterial tests

In order to ensure the highest level of safety is maintained, we routinely will assess the stability of the important ligaments in your upper cervical spine, prior to any assessment or treatment.

3. Temporarily reproduce your headache and migraine symptoms

During our assessment and treatment process, we will be applying gentle and specific pressure to your upper cervical spine in order to temporarily reproduce your headache symptoms. This helps us to identify the specific cause of your headaches.

Occipital Neuralgia – Quick Facts & FAQs

What is occipital neuralgia?

Occipital neuralgia is a headache disorder involving irritation of the occipital nerves, which travel from the upper neck into the scalp. It typically causes sharp, stabbing, or electric shock-like pain. While often mistaken for migraine, it is a distinct neurological condition frequently linked to neck dysfunction.

Common features include:

• Scalp sensitivity or tenderness
• Pain triggered by touch or specific neck movements
• Pain radiating toward the back of the head or behind the eyes

Anatomy of the Occipital Nerve

The Occipital Nerve is actually a group of nerves that arise from between the second and third cervical vertebrae (C2/C3) interact with each other. The Greater Occipital Nerve innervates the semispinalis capitis muscle, as well as the scalp.

The Lesser Occipital Nerve innervates the scalp and behind the ears. The Third Occipital Nerve, also referred to as the Least Occipital Nerve innervates the semispinalis capitis muscle, a small area below the base of the skull, and the C2/C3 zygapophyseal joints.

What causes occipital neuralgia?

In many cases, occipital neuralgia develops when the nerves become mechanically sensitised. This rarely stems from a single cause and is usually a combination of:

• Upper cervical joint dysfunction
• Muscular tightness in the suboccipital region
• Postural loading from prolonged desk work or “tech neck”
• Previous neck injury or whiplash

At Gold Coast Headache and Migraine Clinic™, we assess how these mechanical factors can increase nerve sensitivity.

Vascular causes of occipital nerve irritation

• Irritation of the C1/C2 nerve roots by an aberrant branch of the posterior inferior cerebellar artery

• Dural arteriovenous fistula at the cervical level

• Bleeding from a bulbocervical cavernomas

• Cervical intramedullar cavernous hemangioma

• Giant cell arteritis

• Fenestrated vertebral artery pressing on C1/C2 nerve roots

• Aberrant course of the vertebral artery

Neurogenic causes of occipital nerve irritation

• Schwannoma in the area of the craniocervical junction: schwannoma of occipital nerve

• C2 myelitis

• Multiple sclerosis

Osteogenic causes of occipital nerve irritation

• C1/C2 arthrosis, atlantodental sclerosis

• Hypermobile C1 posterior arch

• Cervical osteochondroma

• Osteolytic lesion of the cranium

• Exuberant callus formation after C1/C2 fracture

How long does occipital neuralgia last?

Duration varies widely. Some experience short flare-ups lasting a few days, while others develop persistent symptoms that continue for months. Because the pain is often driven by neck position and posture, episodes may fluctuate in intensity until the underlying cervical irritation is addressed.

How is occipital neuralgia treated?

Management depends on severity and the underlying drivers of nerve irritation. Short-term relief may involve medication or nerve blocks, however longer-term improvement generally focuses on reducing mechanical sensitivity in the upper cervical region and improving how the neck is functioning under load.

At Gold Coast Headache and Migraine Clinic™, clinicians use a non-invasive approach to guide management where appropriate. The Watson Headache Approach may assist in identifying sensitive upper cervical structures and informing a targeted treatment plan.

Treatment is typically supported with:

• gentle manual therapy approaches where indicated
• movement and load modification strategies
• education around posture and aggravating factors

Is occipital neuralgia serious?

While not life-threatening, occipital neuralgia can be severely disabling due to the intensity of the pain. Because symptoms can overlap with other conditions, a professional clinical assessment is essential to confirm the diagnosis and rule out other causes.

Does occipital neuralgia go away?

Yes. In many cases, symptoms can improve when contributing mechanical factors are corrected. Outcomes tend to be more successful when treatment is targeted early, focusing on resolving the source of irritation rather than relying solely on symptom suppression.

How to diagnose occipital neuralgia?

Diagnosis is based on clinical history, examination of pain patterns, and sensitivity over the occipital nerve distribution. In some cases, diagnostic nerve blocks may be used to confirm the source of pain. Imaging such as MRI may also be recommended to rule out other causes.

Clinicians at Gold Coast Headache and Migraine Clinic™ use detailed assessment methods, including elements of the Watson Headache® Approach where appropriate, to help clarify whether cervical structures are contributing to symptoms.

How Do I Know If I Have Occipital Neuralgia?

(Attacks fulfilling criteria A-E)

Duration	Sudden and brief recurring attacks lasting from a few seconds to minutes
Location	Unilateral or bilateral pain often in the area of the greater, lesser and/or third occipital nerves which are located in the: – Upper neck areas – Base of skull – Radiating upwards toward the scalp – Behind the ear – Toward the top of the head – Forehead or eye
Quality of pain	Shooting, stabbing or electric shock-like pain
Severity	Severe intensity
Other characteristics	The pain is accompanied by the following: – Unpleasant or painful sensations (dysaesthesia and/or allodynia) in response to light touch or gentle stimulation of the scalp or hair – One or both of the following signs: * Sensitivity or tenderness over the course of the affected nerve branches * Trigger points located where the greater occipital nerve exits or within the C2 nerve distribution – Temporary relief of pain is achieved following a local anesthetic injection targeting the affected nerve or nerves

I’ve already tried everything.

What else can be done to help my Occipital Neuralgia?

Many of our patients who suffer from Occipital Neuralgia have tried many different therapies, including:

Medication to relieve pain (painkillers)
Nerve block injections
Anticonvulsant medication
Nonsteroidal anti-inflammatory drugs
Occipital nerve stimulation
Spinal cord stimulation
Botox injections
Surgical treatment

These may have some short-term pain relief or mild benefits, but the pain always returns. This is where the Gold Coast Headache and Migraine Clinic™ can help. We are trained to specifically assess your cervical spine and the sensitivity of your brainstem, to see if they are the true cause of the painful condition. If that’s the case, then we can start Occipital Neuralgia treatment immediately, to cure the cause of your pain and not just cover up the symptoms.

Our Occipital Neuralgia Treatment

At the Gold Coast Headache and Migraine Clinic™, our treatment approach focuses on correcting cervical spine dysfunction and reducing brainstem sensitivity using our world-leading manual techniques. Physical therapy may also play a role in strengthening and stabilising the neck to help treat occipital neuralgia effectively and relieve pain.

Many patients experience noticeable relief within the first six sessions, with 85-90% reporting significant improvements. If you’re ready to take control of your pain, contact us today to begin your journey toward long-term relief—without reliance on occipital neuralgia medication or surgery.

What our clients have said

Excellent

4.9

Andrea Duffy

After being diagnosed with Sunct Trigeminal Neuralgia I was seeking treatment without drugs. After 2 months of treatments with Kevin I'm now pain free. Well worth the effort for a fantastic result, thanks team.

Sarah Jane

Seeing Doug & the team at BHMC has really changed my life, and I’m really grateful for the ongoing care and support. I used to think I had bad vertigo & I would feel dizzy and faint and light headed and nauseous all day everyday and couldn’t work, couldn’t do housework, couldn’t walk my dog, could barely stay standing to shower all because I had been walking around with an unaligned c2 &c3 in my neck due to years of bad posture and constantly hunching over at my desk at work or my head down looking at my phone all day. Migraines 2-3 times a week, constantly feeling pressure in my head and sharp pain, unable to sleep a full nights sleep, and not reacting well at all to prescription medications like valium, replax, and others. I finally got health insurance and headed into BHMC and in the 1st consultation, I was advised of a detailed diagnosis and knew I was in the right place to get help. I’d been struggling everyday for over a year with migraines, had to quit jobs, and was mentally struggling due to these physical symptoms, it was awful. I really wish i’d gone to get physio sooner! Please go and see BHMC, I have been in physio for less than 6 months (probably 10-15 appointments) and have never felt better and more stable. If you go here, try the sessions, buy the pillow, sit up straight, do the exercises, I promise you’ll be better off! Doug has been amazing & so professional, he really knows what hes doing. All the office team is lovely as well!

Samuel Cox

I have been seeing Dr. Woo for about 6 months now and he has been helping me manage my migraines fantastically. I used to get on average 2 migraines a month, now I have gone 4 months with no migraines. The cause of my migraines was very quickly diagnosed and its clear the team here prioritise the goal of self management, not the reliance on medication and continuous appointments. Can recommend to anyone who suffers from Chronic Migraines, it may well be a life changer for you.

Han Wang

My headache problem has been lasting for many years and I suffer from it more frequently from the last 18 months. The quality of my life before treatment was affected tremendously. I simply couldn't enjoy lots of activities when headache attacks occur. I started my headache treatment from the last few weeks and it has been very effective. It is very obvious to how I feel around my neck before and after the treatment. I haven't had any headache episode since. I highly recommend this clinic and the physician named Douglas. He is courteous, gentle, very caring and most amazingly very knowledgeable and skillful. He was able to diagnose my headache issue and provide detailed explainations about my treatment plan and future preventative guidance. I wish I had found this clinic earlier and for anyone who is suffering from headaches you should definitely give it a go. Overall it's a nice and clean clinic, easy public transport and parking. Helpful and friendly admin staff too. Thank you Brisbane Headache and Migraine Clinic Sunnybank Hills.

Celeste Cover

My healthy 7yr old son out of blue started having debilitating migraines about a year ago. Being a nurse I ensured we ruled out anything nasty by doing MRI and seeing specialist. But we kept getting no definitive answer as to why they were reoccuring. Being so young treatment options are limited until 12yrs of age and every episode we would end up at the emergency department with then specialist follow up appointments. Something had to change. I then came across a fellow work colleague (GP) whom referred me to Brisbane Headache and Migraine Clinic. My son has been seeing David now at the spring hill clinic for over 2mnths, where he has worked absolute wonders. My son has had no episodes of a migraine to date yet. David also ensure he educates his clients during the appointment, follows up with exercises and resources for you to use at home as well, easy management plans and a diary to track and see patterns as to why a migraine maybe triggered. I would highly recommend these clinics to anyone suffering. The amount of knowledge and expertise by the staff is amazing. I will always be praising them for the help with my son.

Sahan Amarasena

I have been seeing Sascha for about 3 weeks now. Thanks to Sascha, I have gone from 4-5 headaches a week to being headache free for over a week now. He is very knowledgeable and was quick to diagnose my problem. The treatment plan has been very clear and easy to follow at home. We have addressed all factors that are contributing to my headaches and I am confident of keeping my headaches under control thanks to the tools Sascha has taught me. Highly impressed with the team. They have been very professional, friendly and helpful throughout and been impressed with their customer service. Highly recommend these guys if you are someone who has been suffering with headache for a long time like myself.

Ana Uppman

Mattias and the staff at the clinic are wonderfully helpful and friendly. Mattias in particular helped me to manage chronic headaches and sinus effectively and naturally which has provided a huge amount of pain relief to me especially after so many years of discomfort. Thank you so much Mattias and staff.

Jesse Tamblyn

Diagnosed with Vestibular Neuritis, quickly turned into vestibular migraines of a hellish level. I was hallucinating constantly, pretty much 24/7 for a entire year. With no regular symptoms of a migraine other than extreme light sensitivity, my doctor ordered all the tests, nothing was helping. After a few sessions with Sasch I have zero symptoms and none of my previous triggers are triggering any hallucinations/migraines. Sasch is increadibly skilled at what he does and is very passionate about his clients. I am forever in a debt of gratitude.

kynan jones

I have had cluster headaches on and off for two years now and have had no clue what to do about it, I stumbled across Brisbane migraine and headache clinic, decided to give it a go and I could not be happier with the results from Mattias. My symptoms have dropped by an easy 90% and I can enjoy my days again. Thank you Mattias and thank you Brisbane migraine and headache clinic.

Carter Bennett

So far my treatment at the Headache and Migraine clinic has been very helpful. As someone who experiences migraines often enough, I can say with confidence that after only a few months of treatment with practictioner Mattias, the frequency and severity has been reduced. Still a ways to go till Im migraine free, but I can say with confidence that this very interesting form of treatment works.

ARCHANACHOWDARY NALLAPANENI

David is really wonderful and he is a magician. I've been suffering from migraine headaches for past three years after I met David, and his treatment is like a miracle. I've been on treatment for five weeks now and haven't had any headaches. Thank you heaps David

Rachel de Vera

Best place to overcome your headache pain. This clinic will give you treatment to make your life free from migraine.

Luke Shanley

Ariel from Brisbane Migraine & Headache clinic was the only person that actually helped with my migraines. After seeing doctors & neurologists to no avail i decided to give it a go. I'm able to see friends, nieces & nephews again and working full time. This seemed impossible just over 2 months ago when I first started treatment. Gave me my life back.

Danielle Raftopoulos

I've seen Ariel for neck, back and knee pain/ injuries in the past. She does an excellent job with releasing muscles through dry needling and acupuncture which has relieves pain. Ariel provides exercises to do at home which are helpful. I've also seen all the other physios at the clinic. Highly recommend it.

Pawan Sandhu

I was suffering with bad migraine from last 13 years. Then I heard about Brisbane headache centre. I consulted with Dominic he is very professional and nice Physio. He find out the triggers and started my treatment since i seen him first till now I haven't had any headaches. I highly recommend people if you suffering with headache and migraine please go and consult with the team. Thanks Dominic.

Brooke O'kell

I have had an amazing experience with Ariel at the clinic. I went there in horrific pain after been diagnosed with Trigeminal Neuralgia and I was taking 12 nerve pain tablets a day. The clinic was recommended to me by a friend and I'm so glad I gave them a try because now after a couple of months I am pain free and down to one nerve tablet a day. It's hard to explain really how grateful I really am now to be spending Christmas with my family pain free after not been able to leave the house without crying in pain. I'm would give them 100 stars if I could and I've already recommended Ariel to some friends who suffer migraines. Thank you for everything Ariel your an amazing and lovely lady who really changed my life.

Cathy Biles

I have suffered from migraines for 30 years and I have found that the treatment that I am having at Brisbane Headache and Migraine Clinic is the most effective way I’ve found in preventing a migraine. I have been having treatment with Mattias for around 4 months, and at this stage I still do get some migraines, but they are getting a lot less frequent than they were before I started having treatment. Mattias is very understanding and explains each step of the treatment very thoroughly.

Candy Beanland

Dominic is a very polite person who has helped me a great deal with my migraine headaches. I am very grateful to him.

Emma Zonca

I've had a great experience being treated by Dominic. I was recently diagnosed with Trigeminal Neuralgia and my symptoms have now massively reduced. The care and education I have received have been excellent. All staff have been welcoming and very lovely to deal with since my first appointment. I highly recommend Brisbane Headache and Migraine Clinic.

Ebony Smith

I've been receiving treatment from Mattias for a little over two months now and I cannot recommend this practice enough!!! I have been struggling with Migraine headaches and terrifying aura symptoms for 10+ years and have tried absolutely everything (from medications, diets, all sorts of treatments and multiple specialist/neurologist appointments) in order to eliminate, ease or simply manage the pain. Thank you to Mattias and the wonderful team at Brisbane Headache and Migraine Clinic for listening to my struggles with pain, understanding my issues, applying the right treatment that my body was receptive to...and most importantly.... they gave me a free jar of mints! What a DEAL! 10/10 recommend.

Cassandra Guse

2 months ago debilitating migraines were driving me crazy - and I finally snapped and called this clinic after 3 years of spending most of my spare time just resting and re-habbing my head and neck between work. I started treatments with Dominic immediately. And I am amazed to report that I haven't had a migraine since! I wish I had done it years earlier. Dominic is pleasant, thorough, very knowledgeable and holistic in his advice, picking up on things which seem unrelated but were likely contributing to my headaches - and explains everything every step of the way. I can't recommend him highly enough.

Laura O'hearn

I have only been seeing Dominic from Brisbane Headache and Migraine Clinic for three weeks, but the change in my migraines has been dramatic. I have struggled with chronic migraines for over 20 years and I did not find daily medication helpful in controlling them. I wish I had known about Brisbane Headache and Migraine Clinic sooner as this has been a life-changing experience.

Paul Hewitt

There could not be too much praise for the services and results produced at this Centre . I was suffering clusters of migraines and other neck pain. Went to Doctor, more medication! Decided there has to be a better way. Googled the Headache and Migraine Centre, met with Mattias, and Helen , a few visits and the relief was significant . Small business could take a lesson from their efficiency as well, Admin staff are all over everything, helping you to make appointment times that suit you. If you had or having similar issues to mine..........Just go there .

Chimorne Bekker

Special thanks to Dominic for treating me at the Brisbane Headache and Migraine Clinic. I have had roughly 11 sessions at the clinic and have been headache & migraine free for two weeks today. This may not seem very long, but it is for someone who experiences an attack every second day. My treatment is still ongoing, but the results are already promising. I also have to mention that Dominic was the first specialist to notice that my C2-C3 cervical vertebrae were rotated/disturbed and recommended that we realign the vertebrae and desensitise my brain stem. This was a relief as specialists in the past have diagnosed me with anything from ethmoid sinusitis and occipital neuralgia to labelling it as “psychosomatic“. I would highly recommend anyone suffering from migraines/headaches to arrange a consultation with Dominic.

Megan Tilley

After about 5 weeks of constant headaches, in complete desperation I contacted BHMC and within 4 sessions with Mathias, my headaches significantly reduced in severity and duration. Highly recommended!

Have Questions?

If you have any general enquiries, feel free to use our form on this page to ask us your questions. If you are looking to make an appointment, you can scroll down to make a booking.

Occipital Neuralgia Treatment

The Role of the Occipital Nerve

Anatomy of the Occipital Nerve

What are the possible causes of irritation?

Vascular

Neurogenic

Osteogenic

Muscular

Sensitised Brainstem

How is Occipital Neuralgia Diagnosed?

What To Expect During The Assessment

Occipital Neuralgia – Quick Facts & FAQs

What is occipital neuralgia?

Anatomy of the Occipital Nerve

What causes occipital neuralgia?

Vascular causes of occipital nerve irritation

Neurogenic causes of occipital nerve irritation

Osteogenic causes of occipital nerve irritation

How long does occipital neuralgia last?

How is occipital neuralgia treated?

Is occipital neuralgia serious?

Does occipital neuralgia go away?

How to diagnose occipital neuralgia?

How Do I Know If I Have Occipital Neuralgia?

What else can be done to help my Occipital Neuralgia?

Our Occipital Neuralgia Treatment

What our clients have said

Have Questions?

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