Medications and steroid injections are first-line treatments for occipital neuralgia. Exercises you can do at home or with a physical therapist may complement them.

Occipital neuralgia causes intense pain that most often starts within the base of your head and continues up toward your scalp. It follows along the occipital nerves, which can cause symptoms to affect one side of your head at a time, sometimes both sides.

When you have shooting, aching, and throbbing pain and headaches from occipital neuralgia, one of the last things you may want to do is physical activity.

However, certain stretches and exercises may help complement medical treatments and prevent future pain.

The selection of exercises largely depends on the underlying cause of occipital neuralgia, such as an injury or pinched nerves, so it’s important to speak with a doctor or physical therapist to learn which exercises are best for you.

Below are some occipital neuralgia exercises to consider discussing with a doctor or physical therapist.

Neck stretches

Tight neck muscles are common triggers of occipital neuralgia pain. This is where a neck stretch might help.

In a seated position, try the following gentle neck stretches:

  • Turn your head to the left and hold for 5–10 seconds. Repeat on the right side. You can repeat this up to 10 times.
  • Tilt your head toward your left shoulder and hold for 5 seconds before repeating on your right side. Repeat up to 10 times.
  • Tilt your head forward toward your chest and hold for up to 10 seconds. Repeat up to 10 times.
  • Tilt your head backward until you feel a gentle stretch. Hold for 5 seconds and repeat 5 times.

Chin tucks

A chin tuck is another method that can help relax tight neck muscles.

When sitting or standing, tuck your chin toward your chest without looking down. Hold for up to 10 seconds. Repeat 5–10 times.

Shoulder lifts

Shoulder lifts may also help with neck muscle tightness. To do them:

  1. Roll your shoulders back and keep your neck long.
  2. Gently shrug your shoulders up toward your head and then relax.
  3. Repeat up to 5 times.

Breathing exercises

Breathing exercises can help reduce various types of chronic pain by decreasing activity within the sympathetic nervous system, which is responsible for responding to pain and stress.

With regular practice, proponents say it’s possible to experience better pain responses.

While specific research on breathing exercises for occipital neuralgia is lacking, it’s possible it may help migraine and other headache disorders. For this reason, the American Migraine Foundation recommends regular breathing exercises to help prevent migraine pain.

One technique is called diaphragmatic breathing. To do this:

  1. Place one hand on the middle of your upper chest.
  2. Place your other hand on your stomach, just beneath your rib cage but above the diaphragm.
  3. To inhale, slowly breathe in through your nose, drawing your breath down toward the stomach. Your stomach should push upward against your hand while your chest remains still.
  4. To exhale, tighten your abdominal muscles and let your stomach fall downward while exhaling through pursed lips. Your chest should remain still.
  5. Repeat for up to 20 minutes several times per week.

Another technique is called square breathing. It involves the following process that you can repeat as many times as you’d like:

  1. Inhale for 4 seconds through your nose.
  2. Hold your breath for 4 seconds.
  3. Exhale through your mouth for 4 seconds.
  4. Wait 4 seconds before inhaling again.

If you’re experiencing acute occipital neuralgia pain, you may consider avoiding any exercises that require you to lie flat on your back. This position may press against the associated nerves.

Also, if you try any of the above exercises and experience worsening pain, stop right away and let your doctor know.

As a primary headache disorder, occipital neuralgia symptoms may also improve with the help of physical therapy. This is especially the case with a technique called manual (manipulative) therapy, a common hands-on approach.

While specific clinical studies on manual therapy for occipital neuralgia are lacking, researchers do believe this physical therapy technique may be helpful for numerous types of primary headache disorders.

As one 2022 review points out, the therapy may help:

  • reduce muscle activity
  • decrease the number of headaches
  • alleviate headache intensity

If you’re interested in physical therapy as part of your occipital neuralgia treatment, speak with your insurance provider, as you may need a doctor’s referral.

You might benefit from in-clinic manual therapies. A physical therapist can also teach you exercises to try at home.

Consider speaking with a doctor before trying exercises for occipital neuralgia, especially if you’re recovering from an injury or infection.

Also contact a doctor if your current treatment plan isn’t improving your symptoms, or your symptoms interfere with everyday activities, such as work and sleep.

If you do not yet have a formal diagnosis of occipital neuralgia, reach out to a doctor about testing. The symptoms can be similar to those of other conditions, such as migraine.

Exercises may help alleviate occipital neuralgia symptoms, but they shouldn’t be used in place of medical treatments a doctor might prescribe.

Traditional treatments for occipital neuralgia include a combination of:

  • nerve block injections, which may both diagnose and treat the condition
  • steroid injections to reduce inflammation
  • over-the-counter or prescription pain medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs)
  • anticonvulsants
  • tricyclic antidepressants
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • botulinum toxin A injections
  • topical anesthetics
  • heat therapy
  • surgery

Since most of the available clinical research on occipital neuralgia focuses on medications and surgeries, it’s important to ask a doctor before trying exercises and home remedies.

What is the best exercise for occipital neuralgia?

Neck stretches are among the best exercises for occipital neuralgia. This is because they may help alleviate tight neck muscles that can contribute to symptom flare-ups.

For the best results, you may consider performing the above neck stretches or stretches a physical therapist recommends for you specifically.

How do you calm down occipital neuralgia?

Consider trying heat therapy for a sudden occipital neuralgia flare-up. Over-the-counter heating pads may be effective when applied directly to the source of your pain, such as the bottom of your neck or scalp.

You may also try over-the-counter pain relievers, as directed by a doctor.

While occipital neuralgia is considered rare, living with this painful neurological condition can interfere with your daily activities.

Since the causes of occipital neuralgia vary, it’s important to have an accurate diagnosis before attempting any stretches or other exercises on your own. Consider discussing this further with a doctor.