Pain can be described as an uncomfortable sensation and ranges from annoying and unpleasant to distressing, tormenting, and devitalizing. The severity of pain only depends on the cause. Pain in the back of the head is related to several underlying causes and factors mostly related to posture and position. People who work for long hours in offices and work on computer screens tend to develop pain in the back of the head and neck.
- Cervicogenic headache
- Occipital neuralgia
- Arthritis headache
- Tension headache
- Orthostatic headache
- Cluster headaches
- Spinal headache
- Headache due to lack of sleep
- Hypertension headache
- Hypotension headache
- Cough headache
- Poor posture
1- Cervicogenic headache
The pain originates from the area of injury or tension and is felt in the back of the head. Cervicogenic headaches are mostly caused by any problem arising in the neck like a herniated disc in the cervical spine which causes severe tension and neck pain which may aggravate to cause pain in the back of the head.
- Pain in neck and shoulders
- Pain in the back of the head that aggravates upon lying down
- Sleep disturbance.
Sometimes if a nerve gets compressed this may include some other neurological symptoms like:
- Visual disturbance
- Sensitivity to taste and smell
The problem might be as insignificant as bad posture, falling asleep on high pillows, or long tiresome working hours to a whiplash injury to the cervical spine, disc herniation, and osteoarthritis to name a few. The pain felt is basically due to a pinched nerve in the neck region that supplies the areas affected by it.
In case of an injury, bad posture or an awkward sleeping position the muscles in the neck become tight and inflamed. The inflammation causes pressure on the nerves passing by and thus a headache.
- NSAIDs, muscle relaxants, and other analgesics can help relieve the pain
- Physiotherapy can help with the debilitating pain.
2- Occipital neuralgia
Occipital Neuralgia arises when the nerves (most often occipital nerve) at the root of the neck get compressed due to inflammation of the surrounding muscles causing headaches in the back of the head.
- Pain in the back of the head, neck, and behind the ears
- Tenderness on the scalp
- Pain behind the eyes.
Pain is electric shock-like piercing and throbbing in character that aggravates upon movement and is more often confused with migraine.
- A bad posture, neck or head injury, or tensed neck muscles can be the culprit
- In rare cases, a viral infection may cause nerve irritation.
- Anti-inflammatory drugs can help reduce inflammation
- A heating pad, and neck massage can be used to decrease the pain.
3- Arthritis headache
If arthritis has affected the 1st, 2nd, and 3rd vertebra of the neck namely the cervical vertebrae, it is likely to cause pain in back of head and even in the whole head better known as arthritis headache.
- Pain in the back of the head
- Discomfort and pain in the neck
- Pain behind the ear and in the jaw if the temporomandibular joint is affected.
The pain increases with the movement and the frequency of headaches might increase with growing age
The pain is due to irritation of the nerves that arise from the region affected by arthritis. These nerves innervate the scalp at the back of the head, over and behind the ear, and muscles of the neck.
- The underlying cause of the headache, whether it may be osteoarthritis or rheumatoid arthritis, should be treated.
- NSAIDs have proven to be a very effective treatment.
- Other treatment methods include reducing movement, applying heat, massages, and physiotherapy.
4- Tension headache
A tension headache can cause pain that ranges from sharp pain in the head to slight or building pressure around the head in the form of a band, originating at the occiput. While the severity of stress headaches can range from mild to severe.
- Dull pain or a sense of growing pressure, around the head (in form of a band) that begins at the back of the head
- Tenderness over the skull vault
- Pain and pressure behind the eyes
- Disturbance in sleeping pattern.
Tension headaches are incompletely understood and some physicians consider them a milder version of a migraine.
As suggested by the name, these are caused by:
- Tiredness and fatigue.
- Over-the-counter painkillers: Aspirin and acetaminophen.
- Muscle relaxants: NSAIDs like ibuprofen and naproxen work effectively to decrease inflammation.
- Taking hot showers or neck massages can also relieve the pain due to fatigue.
5- Orthostatic headache
Orthostatic headaches can be easily identified by their relevance to the position. The headaches tend to aggravate upon standing up (in a vertical position) while the pain subsides or reduces to mild discomfort upon lying down (in a horizontal position)
- Pain in the back of head and neck
- Post nasal dribbling
- Visual problems.
This can be due to several causes, namely hypotension, cerebrospinal fluid leak, or even a brain tumor. Thus any other associated symptom should be taken seriously with immediate medical assistance to get to a clear diagnosis.
Other causes of pain in the back of the head can be dehydration, postural orthostatic tachycardia syndrome (POTS), and Anemia.
For proper treatment, the underlying cause should be treated immediately depending upon the severity of symptoms. A physician should be consulted as soon as possible.
6- Cluster headaches
Cluster headaches are cyclic in their nature of repetition. They occur almost daily at the same time for a week or more than that. The pain is generally located at the forehead, behind the eye, on one side of the head, on top of the head, and back of the head. Peaks for 5 to 10 minutes after it starts lasting up to 2 to 3 hours.
- Sharp pain in the back of the head, front of the head, and behind the eyes
- Watery or swollen eyes
- Nasal congestion and discharge
- Agitated or restless feeling.
- Insomnia and other sleeping disorders
- Smoking and alcohol.
For acute attack
- Sumatriptan subcutaneous injection
- Inhalation of 100% oxygen.
For chronic attacks
- Lithium therapy under observation by a health physician is advised.
Migraine is characterized by severe throbbing pain felt mostly in half of the head, but can also be felt on top of the head, back of the head, and whole head.
- Severe headache, throbbing in character
- Nausea and vomiting
- Passing of silvery, shimmering, zig-zag lines
- Development of a temporary blind spot (scotoma)
- Ringing in the ears and Phonophobia.
Migraine begins when overactive nerve cells send out signals to the trigeminal nerve-a nerve that supplies sensation to our head and face, activation of this nerve cause release of certain chemicals which cause blood vessels in the scalp of our brain to swell up, a process called vasodilation, this releases excess neurotransmitters that can cause inflammation and sensation of pain.
- Analgesics: Aspirin, paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antiemetics for nausea: Metoclopramide, domperidone
- Triptans: Sumatriptan is advised for severe attacks
- Excedrin is another drug used to manage severe migraine headaches.
8- Spinal headache
Spinal headaches occur as a complication in people who undergo spinal anesthesia, epidural block, or lumbar puncture, thus are also known as spinal tap headaches. The pain usually begins in the back of the head or forehead and may spread to the whole head.
- A dull, throbbing headache
- Dizziness and nausea
- Hearing loss.
Spinal headache occurs due to a decrease in pressure exerted by the spinal fluid on the brain and spinal cord when a spinal tap, epidural block, or lumbar puncture is performed. This allows a small amount of spinal fluid to leak through it resulting in changes in pressure and thus a spinal headache.
- Hydration: The first step involves keeping hydrated. To raise the pressure exerted by cerebrospinal fluid (CSF). However, if the patient is unable to consume a lot of fluid by the oral route, he is given intravenous fluids.
- Caffeine: Your physician might suggest taking a strong coffee or any other drink high in caffeine.
- Complete bed rest: Bed rest for 24 to 48 hours is mandatory.
9- Headache due to lack of sleep
Headache due to lack of sleep is a common problem seen in individuals with long working hours, depression, anxiety, insomnia, and other sleeping disorders. Headache is usually felt on the top of the head, back of the head, and forehead.
- Lack of concentration
- Lack of coordination
- Redness of eyes.
- Several studies indicate that lack of REM (rapid eye movement) sleep causes more painful headaches. The REM is the part of sleep that involves faster breathing and dreaming. It also is responsible for mood regulation and memory storage.
- Another reason is the formation of proteins in the body that cause chronic pain due to lack of sleep. These proteins work by lowering the body’s pain threshold thus, sparking intense migraines and headaches.
- Analgesics: Aspirin, acetaminophen, ibuprofen.
- Antiemetics: Chlorpromazine, metoclopramide.
- Anticonvulsants: Topiramate.
10- Hypertension headache
Hypertension headache is typically felt in the back of the head and temples in response to high blood pressure.
- Pulsating and throbbing pain in temples
- The feeling of pressure at the back of the head and shoulders
- Facial flushing.
Increased blood pressure leads to leakiness of blood vessels of the brain which disrupts the blood-brain barrier resulting in headaches.
Blood pressure management is the key factor.
11- Hypotension headache
Hypotension headache is not a common phenomenon but several patients with chronic headache conditions have reported hypotension as a trigger. Pain is typically felt at the back of the head but if hypotension triggers any other headache condition, the pain is felt in the respective region.
The Headache is usually mild to severe in intensity depending upon the severity of ischemia in the brain. Other symptoms that can accompany the headache are:
- Blurred vision.
- As the blood pressure drops down, the blood supply to the brain decreases and it does not get enough oxygen and nutrients. This creates a state of hypoxia. Very less blood flow toward the brain can lead to ischemic shock which releases inflammatory mediators that cause hypotension headaches. The pain usually increases upon bending forward or lying down.
- Bradycardia which is a slow heart rate can also decrease the amount of blood pumped by the heart resulting in low blood pressure, lightheadedness, and sometimes even syncope (fainting).
- Low Blood pressure can be due to excessive electrolyte loss by vomiting and diarrhea especially in summers when the body is already on the verge of dehydration resulting in headaches.
- Indomethacin can also be taken for pain relief
- Fluids and electrolytes such as oral rehydration serum are given to combat dehydration
- Hypovolemia due to blood loss can be treated by giving IV fluids and blood transfusions.
12- Cough headache
A Cough headache is classified mainly into two categories; Primary headache and secondary headache. Pain is usually felt at the back of the head and neck due to secondary causes.
Typically has serious symptoms
- Blurred vision
- Loss of coordination
- Cough headache can be just due to exertion as the pressure in the chest and abdomen increases upon coughing which can increase the pressure in the brain and cause a headache.
- A condition named chiari malformation type 1: In this condition, the skull is shaped in such a way that the lower part of the brain named the cerebellum forces itself into the spinal canal. Cerebellum is part of the brain responsible for maintaining balance.
- Cerebrospinal fluid leakage or blockage is responsible for changes in CSF pressure.
- Indomethacin: For inflammation
- The underlying cause needs to be treated
13- Poor posture
Neck stiffness and pain in the back of the head can develop as a result of poor posture. This may last a few hours to a few days until the posture is improved. This occurs mainly from long working hours at the table or in front of a computer screen.
A simple treatment can be OTC analgesics, hot showers, muscle relaxants, and neck, and head massages. Along with this, posture should be improved and a neck rest can be used for long hours at work.
When to consult a doctor?
If the frequency of headaches keeps on increasing and is making you take analgesics more than 15 times a month, consult a doctor.
Why does my headache worsen upon getting up?
The orthostatic headaches tend to aggravate upon standing up, while the pain subsides upon lying down. This can be due to hypotension, cerebrospinal fluid leak, or even a brain tumor. Thus any other associated symptom should be taken seriously.
Why am I having frequent headaches over time?
If you have arthritis and it has affected the 1st, 2nd, and 3rd cervical vertebrae. The nerves arising from this region might get irritated due to inflammation of surrounding tissue. This results in pain in the back of the head and other areas innervated by these nerves. The pain increases with the movement and the frequency of headaches might increase with growing age.
Can a muscle relaxant relieve my headache?
Neck stiffness and pain in back of head can develop as a result of poor posture. This may last a few hours to a few days until the posture is improved. This can be easily treated using muscle relaxants and hot massages.
What other symptoms should I look for with pain in back of head?
This can be due to hypotension, cerebrospinal fluid leak, or even a brain tumor. Thus, you should look for Postnasal dribbling, clear liquid or blood coming out of your nose or ears, and visual problems. In case you have any of these, book an appointment with your doctor as soon as possible.