Recently, while checking my brackets for the NCAA basketball tournaments, my mind turned to the topic of headaches. Martha Torrey wrote a post on this site a couple of months ago about headaches related to the jaw (or TMJ). Since headaches can happen for a variety of reasons, I thought it might be helpful to share some details about headaches caused by occipital neuralgia, a condition that is often helped by physical therapy.

Is the back of your head tender to touch, feel tingly or numb? Do you have brief shooting pain over the top of your head or behind your eyes, pain turning your head from side to side, or a constant aching in the back of your head or neck?

Neuralgia refers to pain within the distribution of a nerve, and occipital neuralgia involves the “greater occipital” and “lesser occipital” nerves that exit the spine between the first two cervical vertebrae (upper part of the neck, just below the back of the skull). These nerves innervate the back of your head, the top of your head and the sides of your head behind your ears. Pain from this type of headache can also be felt behind the eyes.

Is the back of your head tender to touch, feel tingly or numb? Do you have brief shooting pain over the top of your head or behind your eyes (like hitting your “funny bone” in your elbow), pain turning your head from side to side, or a constant aching in the back of your head or neck? These symptoms can be related to occipital neuralgia making it painful to lay with the back of your head on a pillow, turn your head from side to side, or sit for long periods of time. Symptoms are often one sided.

The onset of symptoms may follow trauma such as whiplash or a blow to the back of the head. Poor postural alignment in sitting, or with texting, can cause adaptive shortening of the small muscles at the base of the skull, applying pressure to the greater and lesser occipital nerves (see above).

During a physical therapy evaluation, we will assess your posture, the mobility of the sub-occipital muscles and joints in the upper cervical spine and tenderness to palpation of the greater and lesser occipital nerves as well as other physical factors that may influence the upper neck area.

Physical therapy treatment to improve upper neck mobility and posture, and to normalize muscle tone will be used. These treatments can include soft tissue mobilization (specific massage), joint mobilization (to improve neck motion), postural cues to reduce compression of the structures at the base of the skull and upper neck and exercises to improve spinal stability. Dry needling (insertion of small filiform needles into the affected musculature) can also help to relieve pain and muscle tension.

…imagine that your head is a helium balloon, and would tend to float up toward the ceiling, elongating your neck and bringing your head over your shoulders.

A simple way to achieve improved posture in sitting is to imagine that your head is a helium balloon, and would tend to float up toward the ceiling, elongating your neck and bringing your head over your shoulders. It is also helpful to make sure you use a chair that supports your lower back (lumbar support) by holding it in with a small inward curve not allowing you to slouch.

Many other types of headaches can cause symptoms of headaches in the neck and head, and you should see your healthcare provider to determine if occipital neuralgia may be the cause of your symptoms.

Well, now that I have no teams left in the NCAA tournaments my stress headaches should be over until next year.

~ Jeffrey Clough, PT

Anatomical illustration courtesy of surgicalneurologyint.com.

Leave a Reply

Your email address will not be published. Required fields are marked *