Pain in back of Head: 13 Possible Causes

Pain can be described as uncomfortable sensation and range from annoying and unpleasant to distressing, tormenting and devitalizing. The severity of pain only depends on the cause. Pain in back of head is related to several underlying causes and factors.

  1. Cervicogenic Headache
  2. Occipital Neuralgia
  3. Arthritis Headache
  4. Tension Headache
  5. Orthostatic Headache
  6. Cluster Headaches
  7. Migraine
  8. Spinal Headache
  9. Headache due to Lack of Sleep
  10. Hypertension Headache
  11. Hypotension Headache
  12. Cough Headache
  13. Poor Posture

1- Cervicogenic Headache

The pain originates from the area of injury or tension and is felt in the back of 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 back of head.


  • Pain in neck and shoulders.
  • Pain in back of head that aggravates upon lying down.
  • Sleep disturbance.

Some times if a nerve gets compressed this may include some other neurological symptoms like:

  • Visual disturbance
  • Sensitivity to taste and smell
  • Tinnitus
  • Vertigo


The problem might be as insignificant as a bad posture, falling asleep on high pillows or long tiresome working hours to a whiplash injury to the cervical spine, disc herniation, 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.

Pain in Back of Head

2- Occipital Neuralgia

Occipital Neuralgia arises when the nerves (most often occipital nerve) at root of neck get compressed due to inflammation of the surrounding muscles causing headache in back of head.


  • Pain in back of head, neck and behind the ears.
  • Tenderness at 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 the inflammation.
Heating pad, neck and head massages can be used to decrease the pain.

3- Arthritis Headache

If the arthritis has affected 1st, 2nd and 3rd vertebra of the neck namely-cervical vertebrae, it is likely to cause pain in back of the head and even in whole head better known as Arthritis Headache.


  • Pain in back of head
  • Discomfort and pain in 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 arthiritis. These nerves innervate the scalp at the back of head, over and behind the ear and muscles of neck.


  • Underlying cause for the headache, whichever it may be- osteoarthritis, 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 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 as a milder version of a migraine.


As suggested by the name, these are caused by:

  • Stress
  • Anxiety
  • Depression
  • Tiredness and fatigue.


  • Over the counter painkillers; Aspirin Acetaminophen.
  • Muscle relaxant; NSAIDs like a 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 Headache can be easily identified by their relevance with 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 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 the clear diagnosis.
Other causes for pain in back of head can be dehydration, Postural Orthostatic Tachycardia Syndrome(POTS) and Anemia.


For a 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 upto 2 to 3 hours.


  • Sharp pain in back of head, front of head and behind the eyes.
  • Watery or swollen eyes.
  • Nasal congestion and discharge.
  • Agitated or restless feeling .


  • Insomnia and other sleeping disorders
  • Anxiety
  • 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.

7- Migraine

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, whole head and front of the 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.


Several evidence suggest that the auras characteristic to Migraine, occur due to dysfunctional ion channels causing depolarization and hyperpolarization at the cortical front. This process spreads over cortex at the rate of around 3mm/min that is roughly the time duration an Aura lasts.


  • 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 Headache 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 head or forehead and may spread in the whole head.


  • A dull, throbbing headache
  • Dizziness and nausea
  • Tinnitus
  • 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. In order 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 who have long working hours, Depression, Anxiety, Insomnia and Other sleeping disorders. Headache is usually felt on Top of Head, Back of Head, and Forehead.


  • Nausea
  • 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, dreaming, and is responsible for mood regulation and memory storing.
  • 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 head and temples in response to high blood pressure.


  • Pulsating and throbbing pain in temples
  • Feeling of pressure at the back of Head and shoulders
  • Nosebleeds
  • Facial flushing


Increased blood pressure leads to leakiness of blood vessels of brain which disrupts the blood brain barrier resulting in headache.


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 to the brain. Other symptoms that can accompany the headache are:

  • Headache at the back of Head
  • Light-headedness
  • Confusion
  • Lethargy
  • Dizziness
  • Blurred vision


  • As the blood pressure drops down, the blood supply towards 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 Headache. The pain usually increases upon bending forward or lying down.
  • Bradycardia that is 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 Headache.


  • 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
  • Dizziness
  • Blurred vision
  • Loss of coordination
  • Unconsciousness


  • 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 Cerebellum forces itself into the spinal canal, Cerebellum, is part of the brain responsible for maintaining balance.
  • Cerebrospinal fluid leakage or blockage, which is responsible for changes in CSF pressure.


  • Indomethacin: For inflammation
  • Underlying cause need to be treated

13 -Poor Posture

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 occurs mainly from long working hours at the table or in front of a computer screen.

Simple treatment can be OTC analgesics, hot showers, muscle relaxants and neck and head massage. Along with this, posture should be improved and a neck rest can be used for long hours at work.


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 with passage of time?

If you have arthritis and it has affected 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 back of 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 are the treatment options for arthritis associated headache?

Underlying cause for the headache, whichever it may be- osteoarthritis, 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.

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 Post nasal 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.