Head Pain That Starts at the Base of Your Skull? What to Track and When to Call
A reader wrote in and asked about head pain that starts at the base of the skull, right where the top of the neck meets the back of the head. They wanted to know if this sounds like a normal headache, or something that needs to be checked.
According to Johns Hopkins Medicine, the occipital nerves run from the upper neck into the scalp, and irritation along those nerves can cause shooting, zapping, electric, or tingling pain. That pain can sometimes travel toward one eye, and the scalp may become so sensitive that even lying on a pillow feels painful.
I’m at the age where I don’t love overreacting to every ache, but I also don’t love ignoring weird pain. Especially when it starts near the neck and moves into the head. That’s the kind of symptom worth writing down, because the pattern can help a doctor understand what may be going on.
Can headaches or migraines start at the base of the skull?
Some head pain can start at the base of the skull. One possible cause is occipital neuralgia, which happens when the occipital nerves become irritated, inflamed, compressed, or injured.
The American Association of Neurological Surgeons (AANS) states that occipital neuralgia can cause severe piercing, throbbing, or shock-like pain in the upper neck, back of the head, or behind the ears. The pain may start at the base of the head and move into the scalp on one or both sides.
WebMD adds that occipital neuralgia pain can feel like a sharp, jabbing electric shock in the back of the head and neck. That’s different from a mild pressure headache after a long stressful day.
What can cause pain at the base of the skull?
Someone who has been hunched over a laptop, slept in a bad position, or had a recent neck strain may notice pain starting where the skull and neck meet.
According to AANS, occipital neuralgia can be caused by pinched nerves, muscle tightness in the neck, or a head or neck injury. It may also be linked to underlying problems such as osteoarthritis in the upper cervical spine, cervical disc disease, diabetes, gout, inflammation, infection, or tumors affecting certain nerve roots.
Aurora Health Care states that occipital neuralgia is commonly tied to pinched nerves at the root of the neck or tight neck muscles. In some cases, it can follow a head or neck injury.
Symptoms to track before you call
We recommend tracking the pain like you’d track a strange noise in a car.
This means you should write down where the pain starts, where it spreads, and how it feels. Is it burning, throbbing, stabbing, or electric? Does it shoot behind one eye? When brushing your hair, is it painful? Does your scalp feel tender?
Aurora Health Care adds that occipital neuralgia may cause sharp, shooting pain, usually on one side, along with burning, throbbing, light sensitivity, scalp tenderness, pain behind the eye, or pain behind the ear. It is also highlighted that the severe pain may last only seconds or a couple of minutes, while migraine pain often lasts much longer.
Johns Hopkins Medicine adds that true isolated occipital neuralgia is rare, and migraines can sometimes involve the back of the head, which can make the cause confusing.
When should you see a doctor?
Call a doctor if this is new pain, if it keeps coming back, if it feels sharp or unusual, or if it starts in the neck and shoots into the scalp. AANS recommends seeking medical care when unusual, sharp pain appears in the neck or scalp, especially because occipital neuralgia can be hard to tell apart from migraine and other headache disorders.
Get emergency care if the headache is sudden and severe, follows a head injury, or comes with fever, stiff neck, confusion, seizures, double vision, weakness, numbness, or trouble speaking. The Mayo Clinic lists those as warning signs that need urgent attention.
Most head pain at the base of the skull won’t mean something serious. Still, new or repeated pain deserves attention. Track the pattern, note any symptoms, and talk to a doctor if it feels different from your usual headaches.
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