What Causes Headaches In The Back Of Your Head?

Headaches in the back of your head are most often caused by tension in the neck muscles, problems with the joints in the upper spine, or irritation of the occipital nerves. These are called tension-type headaches, cervicogenic headaches, or occipital neuralgia. While less common, high blood pressure or certain types of arthritis can also cause pain in this area. The exact cause depends on where the pain starts, how it feels, and what brings it on.

What Is the Most Common Cause of Headaches in the Back of the Head?

Tension-type headaches are the most common form of headache worldwide. The American Migraine Foundation reports that up to 78% of people will experience one in their lifetime. These headaches often create a dull, aching pressure that feels like a tight band around the head. The pain can settle at the back of the head and the base of the skull.

The cause is usually sustained muscle tension in the neck, shoulders, and scalp. Poor posture while sitting at a desk, staring at a phone, or sleeping in an awkward position can trigger this. Stress and fatigue also play a big role. The muscles tighten, blood flow changes, and pain signals get sent to the brain.

These headaches are not dangerous. But they can be stubborn. Research published in the journal Cephalalgia found that people with frequent tension headaches often have increased sensitivity in the muscles around the head and neck. This means the muscles stay tight longer, creating a cycle that is hard to break without active treatment.

What Is Occipital Neuralgia and How Is It Different?

Occipital neuralgia is a specific condition that causes sharp, shooting, or electric-shock-like pain in the back of the head. It happens when the occipital nerves — which run from the top of the spinal cord up through the scalp — become irritated or compressed.

The pain is usually on one side but can affect both. It often starts at the base of the skull and radiates upward. People describe it as stabbing or throbbing. The scalp may feel tender to the touch, and light can make the pain worse.

This condition is less common than tension headaches but is often misdiagnosed. The International Headache Society classifies occipital neuralgia as a distinct headache disorder. It can be triggered by tight neck muscles, pinched nerves from arthritis, or even previous neck injuries. Some cases have no clear cause.

Treatment is different from other headaches. Over-the-counter pain relievers often do not work well. Doctors may prescribe nerve blocks, muscle relaxants, or anticonvulsant medications. Physical therapy that focuses on releasing the suboccipital muscles can also help.

What Causes Headaches In The Back Of Your Head That Come From the Neck?

Cervicogenic headaches are secondary headaches — meaning the pain is referred from a problem in the neck, not the head itself. The cervical spine, which is the upper part of your backbone, has joints and nerves that can send pain signals up into the skull.

The cause is often dysfunction in the upper three cervical vertebrae. This can happen from arthritis, a past whiplash injury, or poor posture over many years. The pain is usually one-sided and starts in the neck before moving to the back of the head. It can also spread to the forehead or behind the eye.

Distinguishing a cervicogenic headache from a migraine or tension headache is tricky. One clue is that neck movement often triggers or worsens the pain. Another is that pressing on specific points in the upper neck reproduces the headache.

Physical therapy is the first-line treatment for cervicogenic headaches. A 2021 review in the journal Musculoskeletal Science and Practice found that manual therapy and exercise reduced headache frequency and intensity more effectively than medication alone. Strengthening the deep neck flexors and improving posture are key components.

Can High Blood Pressure Cause Headaches in the Back of the Head?

Yes, but this is not as common as people think. Most people with high blood pressure do not have headaches. The idea that hypertension always causes headaches is a myth.

Research shows that headaches from high blood pressure usually only happen when blood pressure is dangerously high. This is called a hypertensive crisis. The threshold is typically a systolic reading over 180 or a diastolic reading over 120. At these levels, the pressure inside the skull increases, which can cause a throbbing headache at the back of the head.

The headache from a hypertensive crisis is often described as the worst headache of a person’s life. It may come with confusion, chest pain, shortness of breath, or vision changes. This is a medical emergency and requires immediate care.

If you have mild to moderate high blood pressure and get headaches in the back of your head, the cause is likely something else. But it is still smart to check your blood pressure regularly. Uncontrolled hypertension damages blood vessels over time and increases stroke risk.

What Are the Less Common Causes to Be Aware Of?

Several other conditions can cause pain in the back of the head. They are less common but worth knowing about.

Arthritis of the upper spine can cause bone spurs or inflammation that pinches nerves. This is more common in older adults. The pain is often worse in the morning and improves with movement.

Subarachnoid hemorrhage is a rare but life-threatening cause. It happens when a blood vessel in the brain bursts. The hallmark symptom is a sudden, thunderclap headache that peaks within seconds. This is not a headache you wait out. Call 911.

Brain tumors are a common fear, but they rarely cause headaches as the only symptom. When they do, the headache is usually progressive, worse in the morning, and accompanied by neurological signs like weakness, seizures, or vision problems. The American Brain Tumor Association notes that fewer than 1% of people who see a doctor for headaches have a tumor.

Medication overuse headaches can also cause pain in the back of the head. Taking pain relievers more than 10 to 15 days per month can make your brain more sensitive to pain signals. The headache returns as the medication wears off, leading to a cycle of more pills and more headaches.

How Do You Know What Type You Have?

The table below compares the three most common causes of headaches in the back of the head. Use it as a guide, not a diagnosis.

If your headache is new, severe, or different from anything you have felt before, see a doctor. Red flags include sudden onset, fever, stiff neck, confusion, or weakness on one side of the body.

What Actually Helps Reduce These Headaches?

Treatment depends on the cause, but a few approaches help across multiple types.

Posture correction is one of the most effective things you can do. When your head is forward of your shoulders, the muscles at the base of your skull work harder. This strains the occipital nerves and the upper neck joints. Keeping your ears aligned over your shoulders reduces this load.

Stretching the suboccipital muscles directly targets the area where many back-of-head headaches start. Gently tucking your chin and tilting your head forward can release tension. Holding each stretch for 30 seconds is more effective than quick movements.

Heat therapy relaxes tight muscles. A warm towel or heating pad on the back of the neck for 15 minutes can break the muscle tension cycle. Cold packs work better for sharp, inflammatory pain.

Massage therapy has evidence behind it. A 2019 systematic review in the Journal of Bodywork and Movement Therapies found that massage reduced headache frequency and intensity in people with tension-type and cervicogenic headaches. The effect was strongest when massage was combined with exercise.

Avoiding medication overuse is critical. If you reach for pain relievers more than twice a week, you may be contributing to the problem. Talk to your doctor about preventive treatments like amitriptyline, beta-blockers, or botulinum toxin injections for chronic cases.