Understanding Occipital Neuralgia: When Your Headache Isn't a Migraine

It’s natural to think of serious, recurring headaches as migraines. However, there are many shared symptoms with other disorders and headaches, so it’s not always an easy call. Occipital neuralgia is a distinct nerve problem that affects the back of the head and neck, producing symptoms that are often mistaken for migraines. 

At Florida Pain Management Institute in Delray Beach and Boynton Beach, Florida, we specialize in both neuropathy (nerve damage) and migraine care, and by extension, we encounter occipital neuralgia that’s mistaken for migraine. 

For effective treatment, the right diagnosis is important. While many of the same treatments are used for both occipital neuralgia and migraine, pinpointing the type is important due to their different sources of pain. Choosing the wrong treatment can be ineffective. 

Occipital neuralgia

A form of headache disorder, occipital neuralgia results from inflammation of the occipital nerves. These are a set of six nerves (three on each side) that run up the back side of your head and neck, around and over the scalp. 

Sensory nerves serving the scalp and back of the head, inflammation of the occipitals can create episodes of intense pain that may be mistaken for migraines. 

Symptoms of occipital neuralgia

The symptoms of occipital neuralgia can often help you distinguish it from migraines. The most common symptoms include: 

• Sharp electrical pain at the base of the skull
• Radiating pain that extends to the scalp, forehead, and behind the eyes
• Increased sensitivities, such as when brushing your hair, lying on a pillow, or with light touching
• Tender areas on the back of the head and neck
• Attacks are typically short, measured in seconds or minutes
• Symptoms may be on one side of the head or both

By contrast, migraine symptoms differ somewhat, such as: 

• Pounding, pulsing, or throbbing pain, focused on the forehead and temples
• Auras and systemic symptoms, like visual disturbances, sensitivity to light or sound, nausea, or vomiting
• Long-lasting episodes, measured in hours or days
• Symptoms are generally one-sided

Symptoms vary widely between patients, for both conditions, so it’s not always clear-cut which type of headache is at work. 

Diagnosing occipital neuralgia

We’ll review your symptoms and medical history, particularly any headache syndromes you’ve experienced before. Your physical exam focuses on the neck and traces each nerve to identify symptom patterns. 

We may use strategic nerve blocks to pinpoint which nerves are involved, and diagnostic imaging to identify anatomical abnormalities. We’ll also order an exam to rule out migraines and other types of headaches. 

Contact Florida Pain Management Institute at our nearest location. Call 561-331-5050 or click the link on this page to request an appointment for either office. Plan your visit now.