What causes headaches in the back of the head or neck?

Common causes of pain in the back of the head and neck

What causes the back of the head or neck to hurt?

If headache, neckache, and back of head pain plague your daily life, you are not alone. In fact, one in every six Americans experiences chronic headaches

Pain in the back of the head or neck is a common occurrence with many possible causes and treatments. Head and neck pain may seem like it defines your days, but the good news is it can be treated and our pain professionals are here to help identify the cause.

The following are some of the most common causes of pain in the back of the head and neck.

Poor Posture

Poor posture is a common cause of pain in the body, but it especially takes a toll on the neck. “Poor posture” refers to the postural positioning of the head being different than a neutral state. 

A neutral postural state, or “good posture,” refers to when a person’s ears are positioned directly over their shoulders which are rolled back. This posture minimizes stress on the neck and balances the weight of the head on the spine.

Poor posture causes increased pressure on the spine, especially when the head is leaning too far forward. Tension created by poor posture can lead to headaches which are felt as throbbing pain in the base of the skull. 

Correcting unbalanced posture and avoiding sitting or standing in one position for too long can help alleviate these pains.

Arthritis Headache

Headaches are one of the unfortunate side effects of osteoarthritis. Arthritis headaches are felt at the top of the neck where the spine meets the skull. Though the pain is felt in the head, it is caused by inflammation in the neck.

When this occurs, tension from compression of the upper spine is interpreted by the brain as neck pain. The body then limits the blood supply sent to the brain which creates head pain and arthritis headaches.

Tension Headache

Tension headaches are one of the most common types of headaches. This head pain is caused by muscle tension and stress. Pain from tension headaches is usually felt as a constant ache on both sides of the head. They may be chronic and often come on gradually.

Low-Pressure Headache

Low-pressure headaches occur after the removal of cerebrospinal fluid (CSF) during a lumbar puncture (also called a spinal tap). CSF may also be removed from the body if there is a cyst or tear in the spinal cord tissue that results in a leak. 

Headaches occur from the loss of CSF because this fluid cushions the brain by flowing around it, reducing pressure. When CSF is lost, pressure increases resulting in a headache.

Diagnosing low-pressure headaches sometimes requires imaging tests such as an MRI or CT scan. If the headache follows a spinal tap, patients will be given pain relievers, fluids, and caffeine which will aid in producing more cerebrospinal fluid. 

Occipital Neuralgia

Occipital neuralgia is a type of headache that is unique in the way pain is experienced. These headaches are characterized by chronic pain that is described as electric-shock-like in the upper neck, back of the head, and behind the ears. 

The headache is typically felt on just one side of the head and often begins in the neck and moves upwards. People with occipital neuralgia may have a scalp that is tender to the touch and their eyes may be more sensitive to light.

Occipital neuralgia headaches are caused by nerve injury or irritation. This nerve damage is often the result of pinched nerves from tight neck muscles, osteoarthritis, tumors in the neck, or trauma to the back of the head. 


Treatments for Headaches in the Back of the Head or Neck

Treatment for pain in the back of the head and neck varies depending on the cause of the pain. 

The following are treatments that often alleviate this pain:


Massage can provide relief for several different types of head and neck pain, specifically tension headaches and migraines. Massage is an effective form of pain relief and can help prevent headaches from recurring.

Physical Therapy

Physical therapy is one of the most common and effective treatments for head and neck pain. When used correctly, physical therapy can contribute to a reduction in neck stiffness and improved head and neck range of motion, and can teach strategies that prevent pain from coming back. 

The types and frequency of exercises are unique to each individual and their pain symptoms. Physical therapy is usually recommended in cases where the cause of pain is unknown, when the patient is recovering from injury or surgery, or alongside other treatments for headaches. 

Anti-Inflammatory Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often what people experiencing head and neck pain reach for first. These medications include ibuprofen, naproxen, and aspirin and work by reducing inflammation. Acetaminophen may also be used, but it does not have anti-inflammatory properties and is less effective.

Some cases of neck pain caused by inflammation in the spine and surrounding nerves may also be addressed with anti-inflammatory medications. For both types of pain, anti-inflammatory medications should be used only as short-term treatments.

Warm Compresses

Warm or hot compresses are used in temperature therapies to relax tight muscles. The alternative is cold compresses, which have a numbing effect on areas experiencing pain. Warm showers, hot baths, and ice baths are other forms of temperature therapy that will help alleviate some neck pain and headaches.


Botox is known for its ability to hide signs of aging, but did you know that it can also effectively help manage pain? Botox injections work to address pain by target and treat a specific area. Our physicians start by identifying the area causing head tension and then use injections to relax the affected muscle or muscle groups. 


Frequently Asked Questions

When should I be concerned about back of head pain?

You should seek medical advice for any chronic or extreme pain in the back of the head. A doctor will assess your symptoms and develop a treatment plan specific to you.

How serious is pain in the back of the neck?

Pain in the back of the neck can be caused by some serious medical conditions but is usually from postural issues. Seek advice from a pain doctor to assess the severity of your neck pain.

How do you relieve pain at the base of your skull?

Ice or heat therapy, the use of NSAIDs, and neck massage can all help to relieve pain at the base of the skull. This type of pain is often from a condition called occipital neuralgia.

What causes occipital neuralgia to flare up?

Occipital neuralgia can flare up after a traumatic injury to the back of the head or neck. It can also occur spontaneously for no obvious reason.