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Occipital Neuralgia

(C2 Neuralgia; Arnold Neuralgia)



Occipital neuralgia is a headache with pain that starts in the back of the neck or head and moves to the scalp. It involves the back of the head behind the ears. This headache is caused by a problem with specific nerves of the neck called occipital nerves.


Causes    TOP

There are 2 pairs of occipital nerves. They leave the spine high in the neck, just under the skull. These nerves are responsible for sensations of the scalp on the back and top of the head, behind the ear. It can happen for no reason, or as a result of injury or irritation of these nerves.

Injury or irritation of the nerve may be caused by:

  • Trauma to the back of the head
  • Overly tight neck muscles
  • Changes in the alignment of the spine
  • Pressure on the nerves caused by:
    • Blood vessels that surround the nerve
    • Inflammation of the joint, such as arthritis or gout
    • Tumors or cysts that put pressure on the nerves
  • Infection along the nerve
  • Chronic neck tension

Risk Factors    TOP

Factors that may increase your chance of occipital neuralgia include:

  • Current or previous neck injury
  • Previous surgery to the head and neck
  • Structural defects in the spine, neck, or head (congenital or acquired)
  • Repetitive stress or strain on the neck

Symptoms    TOP

Occipital neuralgia causes pain that often starts in the back of the neck or head and moves up the scalp. The pain can be sudden, sharp, burning, or throbbing. Length of time or frequency can vary from person to person. Numbness over the area is another common symptom.


Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. Occipital neuralgia may be difficult to diagnose at first because it has similar symptoms to other types of headaches, such as migraine, tension headaches, and a chronic pain condition called trigeminal neuralgia.

Imaging tests may be done to rule out other conditions or to look for potential causes of neuralgia. The tests will offer detailed pictures of the head and neck where the occipital nerves come from. One of the following may be ordered:

Diagnosis can be confirmed with an occipital nerve block. A needle with numbing medication is inserted near the nerve. If pain is relieved within a few minutes of the injection, than the nerve is likely the cause of the problem.

CT Scan of the Head

Nucleus Image

Copyright © Nucleus Medical Media, Inc.


Treatment    TOP

Treatment goals are to reduce or eliminate pain. You and your doctor will discuss the best options for you. If there is an underlying cause of occipital neuralgia (like a tumor, cyst, or arthritis), it will need to be treated as well.

For most, neuralgia can be relieved with:

  • Heat therapy, which may be dry, moist, or combination of both
  • Massage
  • Physical therapy—to address muscle imbalances or activities causing problems
  • Alternative therapies, such as acupuncture or massage

Medications that may help relieve pain include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants
  • Antiseizure and/or antidepressants may be used for more severe pain

A nerve block or corticosteroid injections may be advised to deliver medication directly to the nerve. A nerve block stops the nerve from sending pain signals. A corticosteroid can reduce inflammation of tissue around the nerve to reduce pressure on the nerve.

Severe or Recurrent Neuralgia

If other treatments fail, surgery may be an option. Some procedures include:

  • Decompression—Moving blood vessels or other tissues that are compressing the nerve to another position.
  • Neurostimulation—Electrical impulses are sent to the occipital nerve to block pain. The stimulator is placed under the skin adjacent to the nerve at the base of the skull. The device works like a pacemaker.
  • Neurectomy—The nerve that causes pain is cut and/or removed. This procedure has permanent side effects that should be discussed with your doctor.

Prevention    TOP

Occipital neuralgia related to other medical conditions may be prevented. Managing chronic conditions of the neck may decrease the chance of occipital neuralgia.

To help decrease the risk of injury to the neck:

  • Use proper technique and protective gear when playing sports.
  • Exercise your neck and back to keep muscles strong and flexible.

American Association of Neurological Surgeons

National Institute of Neurological Disorders and Stroke


Canadian Neurosurgical Society

Public Health Agency of Canada


Therapeutic pain blocks. Johns Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

Heat treatment for neck pain. Neck Pain website. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

NINDS occipital neuralgia information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Occipital-Neuralgia-Information-Page. Accessed February 21, 2018.

Occipital neuralgia. American Association of Neurological Surgeons website. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

Occipital neuraglia. Johns Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

Last reviewed March 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 5/24/2016

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