Electric, not aching. And you can put a finger on it.

THE CONDITION · OCCIPITAL NEURALGIA

Occipital neuralgia is nerve pain from the base of the skull. It is sharp, shooting or electric, usually on one side. It runs toward the crown in brief bursts. A diagnostic occipital nerve block confirms it. No imaging test finds it.

It is electric, not aching. It shoots instead of presses. And pressing one spot brings it on. It is one of the few headaches you can put a finger on. That is exactly why it can be confirmed.

The picture

• Sharp, shooting, stabbing or electric pain from the base of the skull toward the crown.
• Usually one side, following the nerve instead of spreading all over.
• Brief bursts (paroxysms), sometimes on top of a background ache.
• The scalp often feels different — tender, tingling, or oddly numb between attacks. Brushing hair or a pillow can set it off.
• Pressing over the nerve at the base of the skull brings it on. That finding is the key.

Aching, pressing, both-sided pain is not this. Neuralgia means nerve pain. The quality of the pain is what makes the diagnosis.

Why it is confused with migraine, and why that matters

Because it can trigger a migraine-like response — nausea, light sensitivity, a spread forward to behind the eye. So a true occipital neuralgia gets treated as migraine. Preventives are tried and fail, and years pass. The tell is the quality and the trigger point. It shoots instead of throbbing. Pressure brings it on, not movement or effort.

What confirms it

A diagnostic occipital nerve block. If the pain settles within the working time of the anesthetic, those nerves were carrying it. That is not a formality — it is the confirmation. It is also the treatment. No imaging test finds this.

What irritates the nerve in the first place

Usually it is mechanical. The nerve passes through muscle and fascia (connective tissue) at the base of the skull. Steady load on the cervical extensor muscles (the muscles that hold the head up) squeezes it there. Two whole-body drivers decide how loudly that squeeze reports. One is the inflammatory terrain around the nerve. The other is sleep debt, which raises sensitivity. The third is the posture load itself, which comes from the job. Think of a monitor set low, a long drive, overhead work, or a helmet or headset worn for a shift.

That is why blocks work better paired with a change in load than alone. The nerve gets loaded up again on Monday.

Frequently asked questions

Is occipital neuralgia permanent?

No. It often settles, especially when the mechanical load is addressed. Blocks can interrupt the cycle in the meantime.

How is it different from cervicogenic headache?

Quality and mechanism. Occipital neuralgia is shooting nerve pain with a trigger point. cervicogenic headache is an aching pain sent up from the upper neck joints. Neck position brings it on, not pressing the nerve.

Will an MRI show it?

No. Imaging rules out other things. It does not find this. The block does.

What if the block only helps for a few days?

That still confirms the diagnosis, and that changes everything that follows. How long relief lasts and whether to repeat it are then a separate clinical decision.

How duration and repeat blocks are decided is covered on the occipital nerve block page.

Closely related

• The diagnostic block
• Pain at the back of the head
• Cervicogenic headache
• Side-locked pain
• Block or medication