Suboccipital headaches often develop due to nerve compression in the back of your neck. You may have sharp or shooting pain in your scalp that can mimic migraine episodes.

Your occipital bone is the part of your skull found at the lower and back part of your head. “Suboccipital” refers to the space below this bone that contains muscles, nerves, and other important structures.

Suboccipital headaches can form if the nerves in this part of your head become compressed. There are many reasons they may become compressed, such as:

  • arthritis
  • tumors
  • disc degeneration in your neck

A rare condition called a Chiari malformation can also lead to suboccipital headaches.

Read on to learn more about suboccipital headaches including causes, symptoms, and treatment options.

Compression of one of three nerves in the back of your neck can lead to a condition called occipital neuralgia, which is characterized by shooting or stabbing headaches. These nerves include the:

  • greater occipital nerve
  • lesser occipital nerve
  • third occipital nerve

The greater occipital nerve is the source of pain in about 90% of cases. The lesser occipital nerve is the cause in about 10%, and the third occipital nerve is rarely the cause.

Other causes of suboccipital headaches include:

  • irritation of nerves that arise from your upper spinal cord (cervicogenic headache)
  • injury to the muscles at the back of your head
  • Chiari malformation, a condition where brain tissue extends into your spinal canal

Occipital neuralgia is thought to occur in roughly 3.2 per 100,000 people and is diagnosed at an average age of 54, based on data from the Netherlands.

Potential contributing factors for the development of occipital neuralgia include:

Cervicogenic headaches that arise from irritation of the nerves in your neck most commonly occur between the ages of 30 and 44.

The most common type of Chiari malformation occurs in about 0.5–3.5% of people and affects females slightly more than males.

Symptoms of occipital neuralgia include:

  • continuous pain that’s:
    • aching
    • burning
    • throbbing
  • intermittent pain that’s
    • shooting
    • shocking

According to the National Institute of Neurological Disorders and Stroke, pain is typically felt in the:

  • upper back
  • back of the head
  • behind the eyes and ears, usually on one side
  • scalp
  • forehead

Pain generally starts at the base of your head and travels to your scalp on one or both sides. Light movements like brushing your hair may trigger pain. People often describe the pain as similar to migraine or cluster headaches.

Chiari malformation symptoms

Symptoms of a Chiari malformation can include:

Cervicogenic headache symptoms

Symptoms of a cervicogenic headache can include:

  • throbbing head pain
  • pain on one side of your face
  • stiff neck
  • pain around your eyes
  • pain that’s worse with certain neck movements

Occipital neuralgia and cervicogenic headaches can cause pain that impacts your quality of life. Serious complications are rare, but intraventricular hemorrhage leading to death has been reported due to radiofrequency ablation treatment that is rarely used to treat occipital neuralgia.

Many people with Chiari malformation have excellent outcomes, but surgery for severe cases can cause complications, such as:

It’s important to see a doctor if you feel sharp and unusual pain in your neck or scalp, especially if your pain is persistent and doesn’t have an obvious cause.

Tests you may receive to help diagnose a suboccipital headache include:

Mild Chiari malformations are usually evaluated with an MRI in children or adults. More serious forms are often diagnosed before birth with an ultrasound.

Suboccipital headaches can be treated with surgical or nonsurgical treatments.

Nonsurgical treatments

Nonsurgical treatment options for occipital neuralgia or cervicogenic headaches include:

Suboccipital headache exercises

Certain exercises may help strengthen muscles around your neck and relieve headaches caused by nerve compression. A physical therapist can design a custom exercise program to help alleviate your symptoms.

Learn more about exercises for occipital neuralgia.

Surgical treatments

Surgical treatment options include:

  • occipital nerve stimulation to place an electrode under your skin
  • spinal cord stimulation
  • C2 or C3 ganglionectomy (removal of sensory cells from the cervical ganglion in the vertebrae)

Cervicogenic headache treatment

Physiotherapy is usually the first treatment for cervicogenic headaches. Other options include:

Chiari malformation treatment

A Chiari malformation might not need treatment if it isn’t causing problems. Your doctor may recommend surgery if it’s causing symptoms.

Learn more about Chiari malformation surgery.

Many people with occipital neuralgia or cervicogenic have short-term pain relief with treatment. Some people have pain relief with nerve blocks for up to several months.

Mild Chiari malformations aren’t considered life-threatening, but some people may have chronic weakness or trouble walking.

Some of the underlying risk factors for occipital neuralgia are preventable. You may be able to reduce your chances of developing these types of headaches by:

  • eating a healthy diet to help prevent diabetes
  • exercising regularly to help prevent diabetes and degenerative disc disease
  • avoiding smoking to help prevent disc disease (this can be difficult, but a doctor can build a cessation plan that works for you)
  • taking precautions to prevent traumatic injuries
  • maintaining good posture to reduce stress on your neck

Conservative treatments like physiotherapy and medications might be enough to manage your symptoms. You may need surgery if these treatments aren’t effective. Many people have symptom relief with proper treatment.