Pain in the back of my head

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Most of us will experience a headache at some point in our lives, but not all headaches are the same. How intense the pain is, how long it lasts, and its location on your head can indicate whether you are experiencing a typical headache or something more serious. 

Pain at the base of the skull, for example, can be a sign of an underlying medical condition that may require treatment, says Dr. Joey Gee, medical director of the concussion clinic at Providence Mission Hospital. 

Here are four reasons why you might experience pain at the base of your skull and potential treatment options for each cause. 

1. Tension headache

This is the most common type of headache, estimated to affect about two in three adults in the US at some point. 

A tension headache is typically described as a tight feeling across the forehead, but the pain can also extend to the sides and back of the head and down to the neck, Gee says.

Common causes of tension headaches are stress and lack of sleep. But you may also experience a tension headache if you strain a group of muscles at the base of the skull called suboccipital muscles.

These muscles can become tense due to poor posture, eye strain, or another injury, like whiplash. Whiplash, in particular, can be responsible for a tension headache that starts at the base of your skull and extends to the rest of your head.   

Treatment for tension headaches depends on the underlying cause but can include:

• Lifestyle changes, like exercising regularly, stress management techniques, and improving sleep hygiene so you get adequate rest. 
• Over-the-counter pain relievers, like Ibuprofen or acetaminophen can offer temporary relief but if the headaches are recurring, it's important to address the underlying cause.
• Prescription medications, including tricyclic antidepressants or muscle relaxers. 
• Icing or heating your neck and gentle range of motion exercises can help ease pain caused by whiplash. 
• Physical therapy may help improve symptoms through massage and mobility exercises.  

2. Occipital neuralgia

Occipital neuralgia is a condition caused by inflammation or injury to the nerves running from the top of the spine to the head, says Dr. Sean Ormond, a pain management doctor with Atlas Pain Specialists. This inflammation can result in throbbing, shock-like pain at the back of the head or the base of the skull.

Causes of occipital neuralgia include:

• Trauma to the back of the head
• An infection of the nerves 
• Pinched nerves or muscle tightness in the neck
• Arthritis in the upper cervical spine
• Gout
• Diabetes

In addition to throbbing pain at the base of the skull, other symptoms of occipital neuralgia include:

• Pain behind the eyes
• Shooting pains that start at the base of the head and go to the scalp
• An aching or burning sensation at the base of the skull

Treatment will depend on the severity of your condition and your medical history, but may include:

• Physical therapy
• Massage therapy
• Medications, such as muscle relaxers or anti-inflammatories
• Surgical treatments, such as occipital nerve stimulation or spinal cord stimulation, which can help reduce pain by producing electrical impulses to block pain messages between the spinal cord and brain. 

3. Herniated cervical discs

Spinal discs are cushioned shock absorbers that sit between the bones, or vertebrae, of your spine. 

The discs located in your neck are called cervical discs. 

An injury or repetitive strain on your neck can damage those cervical discs, causing them to herniate, or push the inner part of the disc out. This can irritate the tissue and nerves in the area. 

You may be at an increased risk of a herniated disc if you have a family history of herniated discs or you are over the age of 40. This is because disc material naturally degenerates as we age and the ligaments that hold the discs in place also begin to weaken. As a result, a mild strain on the neck or an abrupt twisting motion that wouldn't cause damage in a younger individual can lead to a herniated disc in an older adult. 

If the herniated disc is not pushing on a nerve, you may not experience much pain at all, and the disc will heal on its own. However, if the herniated disc is pinching a nerve, you may experience pain, numbness, and tingling in parts of the body affected by the pinched nerve. 

If the disc is in your neck, you may feel pain in there and at the base of the skull. 

Other symptoms include:

• Pain in your shoulder, arm, or hand
• Weakness in the affected area
• A sharp or shooting pain down your shoulder or arm when you cough or sneeze
• Numbness or tingling in your arms 
• Neck stiffness

Treatment for a herniated cervical disc may include:

• Over-the-counter pain medications, such as ibuprofen or acetaminophen. 
• Prescription medications, such as muscle relaxers
• Physical therapy
• In severe cases, surgery to remove the protruding disc 

4. Medication overuse

People who take pain relievers two or more days a week for headaches may experience "rebound headaches" that can cause pain at the base of the skull, Gee says. 

Doctors don't yet know exactly why frequently using pain relievers can actually trigger headaches in some people, but any acute pain-relieving medication has the potential to lead to medication overuse headaches. 

Some of these include:

• Acetaminophen
• Over-the-counter combination pain relievers, such as Excedrin
• Certain migraine medications, like Zomig or Ergomar

In most cases, medication overuse headaches stop when you stop taking the medication that is triggering them. 

However, if you deal with frequent headaches, simply not taking pain medication may not be an option. Talk with your doctor about the frequency of your headaches, any pain relievers you are currently using to treat your headaches, and the severity of your symptoms. Your doctor may suggest stopping one of these medications or slowly tapering off. 

When to see a doctor

If you experience headaches four or more days a month or your symptoms are interfering with your daily life, talk with your doctor about treatment options. These may include preventive medication or lifestyle changes that can help reduce the frequency of your headaches

Also, seek medical attention if you experience pain at the base of your skull accompanied by:

• Shooting pain down one or both of your arms
• Numbness or tingling in your arms
• Pain behind the eyes
• Shooting pains that start at the base of the head and go to the scalp
• Changes in vision
• Nausea or vomiting

Insider's takeaway

Pain at the base of the skull can be a symptom of the most common type of headache known as a tension headache. Tension headaches are not usually a cause for concern and can be treated with over-the-counter pain relievers.

But pain at the base of the skull may also signal a serious medical issue like occipital neuralgia or a herniated disc.

Treatment options for occipital neuralgia or a herniated cervical disc may include physical therapy, medication, or surgery.