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Occipital Neuralgia: Symptoms, Causes, Treatments, Prognosis

What is occipital neuralgia?

Occipital neuralgia is a chronic pain disorder often grouped with headache disorders. This rare condition describes when headache pain starts at the top of your spine and spreads throughout your scalp. The head and neck pain is intense but brief.

This headache disorder feels like an electric shock or intense migraine, but only for a few seconds — maybe minutes. Migraine headaches last longer than occipital neuralgia and are much more common.

Occipital neuralgia is similar to trigeminal neuralgia, yet different from other headaches or migraines. Trigeminal neuralgia spreads pain throughout the front of your head and face, instead of the back of the head like occipital neuralgia.

This is a somewhat rare disorder. Occipital neuralgia affects an estimated 3 out of 100,000 people each year. That means less than 250,000 people experience occipital neuralgia worldwide.

Can occipital neuralgia be cured? No, occipital neuralgia cannot be cured in the traditional sense. But the pain can be managed, and attacks can be prevented. If you can figure out the underlying cause of your occipital neuralgia and treat it, you should be “cured” as long as the underlying cause does not recur.

Does chiropractic help occipital neuralgia? Yes, chiropractic may help occipital neuralgia! Upper cervical chiropractic adjustments can relieve occipital neuralgia pain, and some experts even claim that chiropractic treatment helps prevent occipital neuralgia from recurring and becoming chronic. 


Patients commonly describe “feeling like there’s an ice pick being driven into my head”. 

The 4 well-known symptoms of occipital neuralgia include:

  1. Brief, intense headache pain
  2. Longer-lasting, dull headache pain
  3. Light sensitivity
  4. Sensitivity to touch

The defining characteristics of occipital neuralgia are where you feel headache pain:

Is occipital neuralgia serious? Occipital neuralgia is not a life-threatening condition. However, occipital neuralgia may hurt your job productivity, school performance, or simply your day-to-day quality of life. That’s why you should seek out treatment for occipital neuralgia if it flares up.

What causes occipital neuralgia?

Occipital neuralgia is caused when one or more of the occipital nerve roots (which are located at the top of your spinal cord) are inflamed or irritated. 90% of the time, occipital neuralgia occurs when the largest of the nerves, the greater occipital nerve, is affected.

To truly understand how this works, you must briefly understand what the occipital nerves are.

There are 3 occipital nerves:

  1. Greater occipital nerve
  2. Lesser occipital nerve
  3. Third occipital nerve

What may irritate or inflame occipital nerves, therefore causing occipital neuralgia?

If your occipital nerves are already inflamed or irritated, touching the back of your head or neck may trigger occipital neuralgia. Even brushing your hair or bumping your head against a headrest may trigger it.

Tests & Diagnosis

It is sometimes difficult to diagnose occipital neuralgia because it shares so many symptoms with other types of headaches, such as migraines or cluster headaches.

To diagnose occipital neuralgia, a doctor may perform the following:

A doctor may inject an occipital nerve block into the affected area, in order to diagnose occipital neuralgia. If the nerve block resolves your headache pain, then your occipital nerves are probably irritated or inflamed.

Treatment of Occipital Neuralgia

There are 9 treatment options for occipital neuralgia:

  1. Chiropractic care
  2. Massage therapy
  3. Over-the-counter medications
  4. Prescription drugs
  5. Injections
  6. Physical therapy
  7. Home remedies
  8. Surgery

Does occipital neuralgia go away? Occipital neuralgia may go away with time if the cause of your occipital nerve inflammation is corrected. 

1. Chiropractic Care

Occipital neuralgia is caused by inflammation or irritation of the occipital nerves. These nerves may be irritated by spinal misalignments, which chiropractors can correct.

Chiropractic care is the gentle manipulation of the spine, which can treat all types of headache pain. A common treatment of occipital neuralgia is chiropractic care, probably due to its non-invasive nature, as well as its non-reliance on side effect-heavy drugs.

Upper cervical chiropractic care is a great way to deal with headache pain while contributing to your overall health.

2. Massage Therapy

Massage therapy describes the gentle manipulation of muscles and soft tissues. Massages are often used to relax tight muscles, including muscles in your upper neck.

Since occipital nerves may be irritated by tight neck muscles, it’s no wonder that massage therapy has great potential in treating occipital neuralgia due to muscle tension.

Massage therapists sometimes use dry needling to treat muscle tension or chronic pain. Dry needling is essentially acupuncture, but based entirely on peer-reviewed research from the past few decades. 

Recent research shows that both acupuncture and dry needling may improve clinical outcomes for occipital neuralgia patients.

3. Over-the-Counter Medications

Doctors may suggest over-the-counter medications for occipital pain relief.

Inflammation of your occipital nerves may cause occipital pain. But inflammation of surrounding muscles or blood vessels can pinch and irritate occipital nerves, resulting in a sort of secondary occipital neuralgia.

Ibuprofen (Advil) is a common anti-inflammatory medication for nerve pain management. It reduces inflammation that can lead to the shock-like pain associated with occipital neuralgia.

However, beware of the side effects of ibuprofen and similar drugs. Side effects of ibuprofen include:

4. Prescription Drugs

Doctors may also prescribe prescription drugs to relieve occipital neuralgia pain, such as muscle relaxants or antidepressants.

Muscle relaxants should relax the muscles around your occipital nerves, taking pressure off those nerves and offering occipital pain relief.

Anti-seizure meds, tricyclic antidepressants, and SSRIs (selective serotonin reuptake inhibitors) are all common prescription drugs used to treat occipital neuralgia. These all come with a laundry list of serious side effects, so it’s important to discuss these with your doctor before going this route.

5. Injections

Doctors may also administer injections to relieve occipital neuralgia Since injections are more invasive than other treatments, these are often a last resort in the case that nothing else works.

Local anesthetic may be injected near the occipital nerves, bringing up to a year of occipital pain relief. (As long as you don’t treat the underlying cause, occipital neuralgia will likely return eventually.)

A 2018 meta-analysis shows that botox (botulinum toxin) injections may be a safe and effective treatment for occipital neuralgia.

6. Physical Therapy

Physical therapy is a common method of relieving occipital pain due to muscle tension, poor posture, or neck injury.

A physical therapist may instruct you on how to stretch or exercise so that your neck becomes stronger, yet less tense. He/she may educate you on exercises and stretches you can do to help with occipital neuralgia — first in a clinical setting, but late at home by yourself.

Chin tucks are the most common stretch for occipital neuralgia. Chin tuck benefits include:

Discontinue any stretches or exercises that cause you pain.

7. Home Remedies

There are a few home remedies for occipital neuralgia. These are non-invasive, inexpensive, and side effect-free.

Effective home remedies for occipital neuralgia include:

  1. Rest
  2. Warm compress
  3. Self-massage

You may also want to try all-natural anti-inflammatories that may reduce inflammation in or around your occipital nerves.

Consider trying these all-natural anti-inflammatories:

  1. Cucrumin (turmeric)
  2. Cat’s claw
  3. Green tea
  4. Resveratrol
  5. Omega-3 fatty acids (fish oil)
  6. Capsaicin (chili pepper)
  7. Boswellia (AKA frankincense)
  8. White willow bark
  9. Maritime pine bark

8. Surgery

Surgery attempts to correct several issues that may be triggering your occipital pain.

This is a more long-term treatment option for occipital neuralgia, as opposed to the short-term solutions like ibuprofen. As long as you don’t address the root cause of your occipital neuralgia, it will come back. 

Occipital release surgery involves making small incisions to un-pinch occipital nerves. Sometimes, inflamed tissue needs to be incised to release pressure off of your occipital nerves, in order to prevent future occipital neuralgia attacks.

If your occipital nerves are compressed due to osteoarthritis or rheumatoid arthritis, surgery may be used to ease the nerve pressure.

A ganglionectomy is a surgery meant to disrupt nerve clusters that may contribute to occipital pain.

Neurosurgeons may surgically place electrodes under your skin to stimulate the occipital nerves, or perhaps between your spinal cord and vertebrae. These electrodes are meant to block pain messages travelling through your nervous system.

In extreme cases, a surgeon may sever the greater occipital nerve. This will lead to scalp numbness.


There are several ways to prevent inflammation or irritation of the occipital nerves that causes occipital neuralgia:

If your occipital nerves are already inflamed or irritated, avoid touching the back of your head or neck, unless you have to. In that case, be very gentle.

Prognosis & Long-Term Outlook

Occipital neuralgia is a rare condition that affects a couple hundred thousand people every year across the globe. Although the pain is manageable, this disorder is not necessarily curable.

But with high-quality treatment, you can treat occipital neuralgia pain and even prevent future attacks.

If you are suffering from frequent headaches, consider upper cervical chiropractic care. At Denver Upper Cervical Chiropractic, we use evidence-based techniques to gently manipulate the spine. Most headache pain can be relieved with spinal adjustments.

Click here today to make an appointment with us!


  1. Djavaherian, D. M., & Guthmiller, K. B. (2019). Occipital Neuralgia. Full text: https://www.ncbi.nlm.nih.gov/books/NBK538281/
  2. Stall, R. S. (2013). Noninvasive pulsed radio frequency energy in the treatment of occipital neuralgia with chronic, debilitating headache: a report of four cases. Pain Medicine, 14(5), 628-638. Full text https://academic.oup.com/painmedicine/article/14/5/628/1816050
  3. Mallory, M., Bauer, B., & Chon, T. (2019). Occipital Neuralgia Treated With Acupuncture: A Case Report. Global Advances in Health and Medicine, 8, 2164956119890546. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883661/
  4. Bond, B. M., & Kinslow, C. (2015). Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia. The Journal of the Canadian Chiropractic Association, 59(2), 101. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486992/
  5. Choi, I., & Jeon, S. R. (2016). Neuralgias of the head: occipital neuralgia. Journal of Korean Medical Science, 31(4), 479-488. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810328/
  6. Meng, F., Peng, K., Yang, J. P., Ji, F. H., Xia, F., & Meng, X. W. (2018). Botulinum toxin-A for the treatment of neuralgia: a systematic review and meta-analysis. Journal of Pain Research, 11, 2343. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190814/
  7. Maroon, J. C., Bost, J. W., & Maroon, A. (2010). Natural anti-inflammatory agents for pain relief. Surgical Neurology International, 1. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011108/

Dr. Ty Carzoli

Denver Chiropractor Dr. Ty Carzoli, located in Glendale near Cherry Creek and Wash Park, offers the best in research-based pain relief and wellness care, with an emphasis on gentle treatment delivery. Dr. Carzoli is honored to be the only Chiropractic Orthospinologist in the state of Colorado. The mission of Denver Upper Cervical Chiropractic is to help community members have a better life, regardless of their age, vitality level or physical condition. Our practice is family-friendly and caters to the comfort and well-being of every practice member — from infants to seniors.
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Overall, I didn’t necessarily feel that I had any particular issues other than a prior shoulder injury that slightly bothered me when I exercised with a heavy set of weights. I felt fairly energetic due to the typical routine of exercise and eating a well balanced healthy diet. The idea for my treatment was to be more proactive about my long term health and ensure that I was in proper alignment.
After my initial consultation, I found out my body was out of alignment more than I felt. I did not feel much different after the first few adjustments; however, what I did not realize until a few weeks in is that I had been waking up prior to treatment with kind of a groggy kind of feeling. After years of waking up like this I assumed this was just the norm. I now have been waking up with little fatigue and grogginess (even with a 10 month old baby) and a new burst of revitalization even if I did not get a full 8 hours of sleep. The feeling of being excited the day before a trip has been occurring on the standard day getting up for work. My workouts have also seen an improvement with the new improved energy levels as well as the standard weight I typically lift went up with little efforts.
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Even if you think that you have a good alignment, you should be sure to visit Dr. Ty for a great proactive health care plan!

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