WHERE IT HURTS · THE BACK OF THE HEAD
A headache at the back of the head usually comes from one of four sources: the upper neck joints, the occipital nerves, a tension-type pattern, or migraine presenting at the back of the head.
It is the most searched headache location and the least specific one. Four different body parts send pain to the back of the head. They are told apart by what the pain does, not by where it sits.
What causes a headache at the back of the head?
THE UPPER NECK JOINTS
- Pain that starts at the base of the skull and spreads up and forward. It is usually on one side, and usually the same side every time.
- Provoked by holding the head in one position — a long drive, a monitor set too low.
- Often comes with a stiff, restricted neck that you had stopped noticing.
THE OCCIPITAL NERVES
- Sharp, electric or shooting, not aching. It runs from the base of the skull toward the crown.
- The scalp may be tender or oddly numb, and brushing your hair can be unpleasant.
- Pressing one specific spot at the base of the skull reproduces it.
TENSION-TYPE PATTERN
- Both sides, a steady press rather than a throb, no nausea and no aura.
- Builds through the day and is worst in the late afternoon.
MIGRAINE PRESENTING POSTERIORLY
- Migraine is not always in the front. Migraine at the back of the head, with nausea and light sensitivity, is common enough to catch people off guard.
- The giveaway is the company it keeps — sensitivity, nausea, needing a dark room — not the location.
Can the location of a back-of-head headache tell you the cause?
The back of the head is where several nerve zones meet. The upper cervical nerve roots (the nerves of the upper neck) and the trigeminal system share a relay station in the brainstem. So a problem in the neck can be felt in the head. And a primary headache disorder can be felt in the neck. That overlap is why “it hurts here” is a starting point and not an answer.
What really separates them is how the pain behaves. What brings it on? Is it always the same side? Does pressing one spot bring it on? What else comes with it? That is a history, and it takes longer than a scan.
WHEN BACK-OF-HEAD PAIN IS NOT ROUTINE
- Sudden onset reaching full intensity within about a minute.
- With fever, a stiff neck, or a rash.
- After a head or neck injury.
- With new weakness, vision loss, slurred speech or unsteadiness.
- These belong in the emergency department — the full list.
Why does a headache at the back of the head keep coming back?
Whichever part is making it, how often it comes tracks the load on that part. Two of those inputs are biological. Steady, held load on the neck extensors (the muscles that hold the head up) keeps the upper cervical joints irritated. Unstable blood sugar widens the swings a headache-prone brain has to absorb. The third is your working day — a monitor height, a shift length, a commute. It is usually the one nobody asks about. Counting the days is what makes the pattern visible.
Frequently asked questions
Why does the back of my head hurt every day?
Daily pain in one place is a frequency problem before it is a location problem. At that rate, the medication count matters as much as the headache count. Start with the two numbers and check whether overuse has become part of it.
Is back-of-head pain coming from my neck?
Often, yes — the upper cervical joints and the occipital nerves are two of the four candidates above. A headache driven by the neck can be found on exam. That is the useful part.
The cervicogenic headache page goes through it in detail.
Do I need an MRI for this?
Usually not. With a normal exam and none of the warning signs, imaging changes the plan in very few cases — when a scan is actually indicated.
Which doctor should I see for it?
If the diagnosis is unclear, neurology. If it is fairly clear and nothing has controlled it, an interventional pain physician, because a diagnostic block becomes an option — the comparison.
When should I worry about a headache at the back of the head?
Go to the emergency department if it comes on suddenly and reaches full strength within about a minute. Go if it comes with fever, a stiff neck or a rash. Go if it follows a head or neck injury, or if it arrives with new weakness, vision loss, slurred speech or unsteadiness. Without those signs, back-of-head pain is usually the neck joints, the occipital nerves, a tension-type pattern or migraine.
What does a headache at the base of the skull mean?
Pain that starts at the base of the skull usually points to the upper neck joints or the occipital nerves. Neck-joint pain spreads up and forward, stays on the same side and follows a fixed head position, such as a long drive. Occipital nerve pain is sharp or electric, runs toward the crown, and pressing one spot at the base of the skull reproduces it.
How do I get rid of a headache in the back of my head?
First find out which of the four sources is making it. The history and the exam tell them apart, not a scan. How often it returns follows the load on that part: a head held in one position, a monitor set too low, unstable blood sugar and the shape of your working day. When a neck source is likely and nothing has controlled it, a diagnostic block becomes an option.
Nearby, if this is not quite it
- The temples
- One side only, every time
- It wakes you at night
- What to bring to a first visit
- When it is an emergency
A location is a clue, not a diagnosis
The examination separates four candidates that all hurt in the same place. Bring two weeks of a diary and we will start there.
12174 Natural Bridge Rd, Suite 304
St. Louis, MO 63044
Next to DePaul Hospital, off the I‑270 and I‑70 junction, west of the airport.
Sources
- Piovesan EJ et al. Cervicogenic headache – How to recognize and treat. Best practice & research. Clinical rheumatology, 2024. PubMed 38388233
- Pan W et al. Occipital Neuralgia. Current pain and headache reports, 2021. PubMed 34287719
- Lefel N et al. 11. Cervicogenic headache and occipital neuralgia. Pain practice : the official journal of World Institute of Pain, 2025. PubMed 39219023
- Jull G. Cervicogenic headache. Musculoskeletal science & practice, 2023. PubMed 37301672