On average over 5000 people enter "headache back of head" into Google each month.
I have hand searched the medical journals 'Cephalalgia' and "Headache" to identify these 38 causes of pain in the back of the head.
You can organise the causes of "headache back of head" as follows:
Cervicogenic headache is by far, the most common cause and is a pain that originates in the upper part of neck.
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The most common of these is a pain referred from the joints of the upper spine. This is called cervicogenic headache (cervic = neck, genic = caused by).
The classic cervicogenic headache causes a pain in the back of the head - on one side only.
The pain can spread up the back of the head and round the side towards the ear or over the top into the forehead.
Most people with cervicogenic headache will have previously injured their neck (a whiplash injury is typical).
Other people will have had minor injuries (often forgotten) or adopt postures or habits that contribute to poor posture, which can predispose to pain.
In my experience, most middle-aged/older people referred to me with a severe one-sided headache that's been going on for months will have cervicogenic headache.
In these older people there are restricted neck movements due to "wear and tear" of the joints of the upper spine (facet joints).
Cervicogenic headache is very common - as many as 4% of adults will have this pain at some point in their lives.
Fortunately Cervicogenic Headache Treatment can be effective, and is the most common headache that might respond to physical treatment, without resorting to medication.
This another severe, sharp "headache back of head" that spreads up to the top of head or into the eye on the same side.
Most people who have this label will actually have abnormal neck examinations, and the term cervicogenic headache is probably more appropriate. There is more on occipital neuralgia here.
Migraine is not, in my experience, a common diagnosis in people who ask me for advice about their "headache back of head".
One survey from the 1970s (Olesen, Denmark) found that only 6% of people with acute migraine took pain in the back of the head.
A more recent survey in 2005 (Kelman, Atlanta) found that about 39% of people with migraine would report pain in the back of head or even in the neck.
Many people with migraine will also have undetected dysfunction of the upper cervical spine and may be helped by an assessment by a physiotherapist. Treating the neck can be beneficial in people who describe migraine, especially if it is a "headache back of head" as well as more typical migraine symptoms.
About 35% of all people will get these brief intense pains in the head lasting a few seconds (This information is from a large Norwegian Study called the Vaga Study).
They appear out of the blue, and may make you wince, or feel briefly weak at the knees if they are very intense. In a small number of people, these ice-pick pains are located, exclusively, in the neck or very back of the head.
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The occipital arteries run up the back of the head, and are often affected in temporal arteritis.
As the occipital arteries lie right next to the greater occipital nerve, temporal arteritis can cause a "headache back of head". (I've made this mistake once before, but the penny dropped at follow-up and a good recovery came on with steroid treatment!).
About 30 people per 100,000 will get temporal arteritis in any given year. The diagnosis requires an ESR blood test and a temporal artery biopsy procedure. Temporal Arteritis requires immediate treatment with steroids.
This may present with a sudden severe "headache back of head", but is even more rare than arteritis at about 5 people per 100,000 each year.
The best way to distinguish vertebral artery dissection from cervicogenic headache is to listen to the onset of pain.
Statistically, cervicogenic headache is about 800 times more common than vertebral dissection.
About 10% of people who come to hospital with a very sudden
onset severe pain in the back of the head will be diagnosed with a brain
haemorrhage called Subarachnoid haemorrhage. If due to a ruptured berry aneurysm, prompt diagnosis and treatment is essential. If a ruptured aneurysm is missed, the second bleed can be devastating.
This sudden severe headache is called "Thunderclap Headache".
If this pain happens out of the blue it requires immediate medical attention.
If at the time of onset of pain there is vomiting or a faint, the risk of there being an underlying brain haemorrhage is higher than in those who had pain and no other symptom.
The majority of these are experienced as sudden severe pains in the occipital area. It is now thought that if you get these headaches they are almost all due to a condition called Reversible Cerebral Vasoconstriction Syndrome.
4/98 mountain climbers at high altitude experienced their pain in the back of the head. Most of the headaches involved the entire head. and about half were made worse with exertion.
One series of 83 cases of headaches triggered by coughing found no cause in 74 cases. Of these 74 cases, 35% were in the back of the head. In the 9 cases with a cause found, 4 had occipital pain (44%). Cough Headache requires investigation. The most common cause found is a condition called Chiari malformation.
About 50% of people on dialysis for kidney failure will get a headache after dialysis sessions. In 8/30 dialysis headaches in one paper, the back of head was the site of the pain.
People who play pool for prolonged periods of time may experience pain in the head and neck after playing for between 3-6 hours.
There is one report of this, and the problem is presumably from the joints of the neck, such as over extension at the atlanto-axial joint. This is probably a form of cervicogenic headache.
Headache referred from the heart can be felt in the back of the head. In 11/32 published cases, reviewed in 2008, pain in the back of the head occurred during either an angina attack or heart attack proper. Treating the heart disease fixes the headaches.
This is a rare treatable headache that wakens from sleep almost every night, usually at about the same time. If you have this type of headache you go to bed pain free, and it is the onset of headache that compels you to get up fromlying. A drug called Lithium Carbonate helps about 70%.
This is an unusual back of the head syndrome. It is provoked by rotation of the neck which irritates the C2 nerve and produces a sensory disturbance in the tongue.
Pain in a low pressure headache can be experienced anywhere, but most commonly it is on both sides of the head.
Some people will report a severe dull ache in the back of the head that is worse while up and about, and is relieved by lying down flat for 15-30 minutes.
Low pressure headaches are often associated with a muffling of hearing or buzzing in the ears that is also better on lying down.
Disease of this joint can irritate the C2 nerve and cause intense sharp pains going up the back of the head. They can even cause the eye to water. Rheumatoid arthritis is the most common serious cause of this problem. Other conditions that can affect this joint or the C2 nerve include a neuroma, meningioma or pressure from a nearby blood vessel. This condition will require specialist investigation and treatment.
Almost everyone who gets occipital condyle syndrome will have a known history of cancer elsewhere eg prostrate or breast. This causes a severe occipital pain due to spread of cancer into the occipital bone at the base of the skull. The XIIth cranial nerve passes through this bit of bone and supplies the muscles of the tongue. Severe headache usually comes on a few weeks before the tongue movements start to cause speech or swallowing difficulty.
Even without an occipital condyle syndrome hypoglossal nerve palsy can be painful. This may be due to compression of the inflamed nerve in the hypoglossal canal, but the exact mechanism is not certain.
Pain in the neck and shoulder are common if the Accesory Nerve is damaged - the usual cause is surgery in the neck to biopsy or remove a lymph gland. The pain can spread into the back of the head. The shoulder on the affected side loses its contour compared to the other and drops down.
A low lying course of the posterior inferior cerebellar artery has been identified in persistent pain in the back of the head.
The classic pain of Chiari Malformation is in the back of the head and is provoked by coughing, exertion, laughter or sneezing, so without these provoking factors a Chiari is less likely to be the cause.
One case of a teenage girl with fixed, one sided severe pain in the back of the head due to an accessory bone joining head to neck, which was relieved when the accessory bone was removed surgically.
Single case of severe pain in the back of the head associated with a vascular lesion in the upper spinal cord.
Epicrania Fugax is a variant of ice-pick pains. What is different is that these are even shorter in duration and seem to "zig-zag" through the head. 4 out of 10 cases in one series had pain starting at the back of the head and zig-zag their way through to the front of the head. No serious cause is found.
This is a localised, fixed area of pain the size and shape of a coin. It is thought to be due to inflammation of one of the cutaneous nerves of the scalp, and is more a nuisance than a serious disorder.
26% of one series of 652 cases experienced cluster pains in the back of the head. Oxygen and Sumatriptan injections work best for acute attacks. Verapamil is the best preventative drug
This is a strictly one-sided headache and in most cases is at the front and side of the head. In one series 1/18 had the back of the head as the main site of pain. In another 5/18 there was some pain there, but it was not the main site of pain.
80% of these people recall the onset of new headache several months earlier and the pain seems to persist, and no cause is found. Some of these are associated with a viral infection. 64% have bilateral pain and 60% have headache in the back of the head. In 55% the pain is described as throbbing at times and 54% report pressure symptoms at times, and some experience both throbbing and pressure.
This pain in the back of the head is severe to the point of preventing sleep. It has its onset over about 1-2 days and is associated with pain on swallowing.
35% of people with previously known Parkinson's Disease in one survey had a non-descript bilateral posterior neck and head pain. "Coat-hanger Pain" is described in people with a variant of Parkinson's Disease called Multiple System Atrophy - they get a pain in the neck and back of head that feels like they are being suspended on a coat-hanger.
11/51 people in one series of people with brain tumours reported pain in the back of the head. However, headache in the back of the head is not a distinctive feature of brain tumours. Most brain tumours present with other neurological symptoms such as epileptic seizures.
Sleep apnoea and heavy snoring increase the risk of chronic headaches. 22% of headaches associated with sleep aponea in one series were located in the back of the head. Treating sleep apnoea will often help the headache.
In 8/58 cases = 14%, headaches were in the back of the head. The quality of pain is pulsatile or throbbing in 83% and assoc with nausea in 57% and a feeling of stiff neck in 59%. The biggest risk for developing this condition is obesity and weight reduction through a properly directed exercise and diet programme can be curative.
One case of a relapse of Graves Disease (over active thyroid disease) was associated with 2 months of severe headache in the back of the head.
Dengue Fever causes a fever and headache. 97% of Dengue Fever cases will have a prominent headache, of which about one in five will be in the back of the head. Headache is more pronounced in ordinary Dengue fever than in its more dangerous counterpart Dengue Haemorrhagic Fever.
This is a cause of thunderclap headache, and like most thunderclap headache is experienced in the back of the head.
This is an 'evidence-based' list - gleaned from a systematic search of medical literature.
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If there are no references listed, please notify me, as this box should contain a list of information sources, or a link to a 'Systematic Review' of the topic discussed on this page.
Goadsby P. Cervicogenic headache: a pain in the neck for some neurologists? The Lancet Neurology 2009;8: 875-877.
L Kelman. Pain characteristics of the acute migraine attack. Headache 2006;46:942-953.
LJ Stovner. Headache Associated With the Chiari Type I Malformation. Headache 1993; 33:175-181.