What Causes Headaches in the Back of the Head and Neck? - AICA Orthopedics (2023)

While headaches are a very common ailment that everyone has dealt with, many don’t realize how many types of headaches there are. Everything from the location of the pain to what it feels like can vary depending upon the cause of the headache, and this information can be crucial to understanding if there is a severe cause for the condition. Any pain in any region of the face, head, or neck is technically considered a headache- but what exactly causes the kind of pain that is in the neck and the back of the head? Read on to understand this phenomenon and what kind of headache treatment is right for these symptoms.

Types of Headaches

In general terms, a headache is any pain that originates in the face, head, or neck. However, the International Headache Society categorizes over 150 types of headaches that a person can suffer from, with three main categories. These are:

• Primary headaches are headaches with no clear underlying cause. They may result from overactivity or strain, like a headache that comes from sleeping in an odd position. These are usually not life-threatening or of great concern, but they can impact quality of life. Primary headaches include tension headaches, migraines, and cluster headaches.
• Secondary headaches are a result of underlying medical conditions like infection, injury, tumors, bleeding in the brain, or even life-threatening causes. Examples include a sinus headache or a medication overuse headache.
• Other headaches include headaches, facial pain, and pain involving the 12 cranial nerves that don’t fall into the other categories. An example is a trigeminal headache.

Each of these categories may be treated differently depending on how they present and how the person is impacted.

Headaches in the Back of the Head and Neck

Certain types of headaches are more likely to cause pain in the back of the head and the neck than others. For example, a sinus headache will cause pain in the sinuses, which sit at the front of the face- it is unlikely neck pain is a result of a sinus headache. Below are some types of headaches commonly associated with pain in the back of the head and the neck.

Tension Headaches

The most common cause of pain in the back of the head is a tension headache. These headaches can last anywhere from 30 minutes to seven days and are usually associated with pressure or tension in the back of the head. The tightening feeling may stretch around to the front of the head and can range from mild to severe.

Tension headaches can be a response to situational issues, like sleeping with the neck in an odd position or more chronic lifestyle factors. Severe stress, fatigue, a lack of sleep, skipping meals, bad posture, and a lack of hydration are all commonly associated with an increase in tension headaches.

Common treatments for tension headaches include lifestyle modifications, painkillers, massage, and relaxing techniques like meditation. Occasional headaches in this category are not a cause for concern, but recurrent or severe headaches should be reported to a doctor.

Migraine

A form of recurring headaches, migraines often begin in childhood and increase with frequency over time. While they are most commonly seen in females, anyone can experience migraine. They are categorized by severe pain on one side of the head, nausea or vomiting, and visual disturbance. It is also common to experience sensitivity to sound, taste, and light or have the pain worsened by physical activity. The pain may last anywhere from a couple of hours to several days.

The exact cause of migraine is not known, but they can often be triggered in those who are prone to emotional and physical stress or dietary changes, as well as certain medications. Painkillers and resting in a dark room are usually used to manage pain, while some lifestyle modifications and medications like triptans can help manage the condition more long term.

Medication Overuse or Rebound Headaches

When a person uses too many painkillers, they can develop a medication overuse headache. These typically begin after stopping pain medication and are characterized by persistent and severe headache pain. Other symptoms may include nausea, fatigue, anxiety, irritability, restlessness, trouble concentrating, loss of memory, or even depression.

The best treatment for these headaches is to stop taking the pain relief medication entirely. Headaches will worsen at first and quickly resolve, though this should be done under the supervision of a doctor. Some people may require physical or behavioral therapy to break an addiction to medication as well.

Occipital Neuralgia

This rare but severe headache usually begins in the base of the neck, spreading up to the back of the head and behind the ears. It occurs when there is damage or irritation to the occipital nerves, which run up the back of the neck to the base of the scalp. This nerve damage and irritation can result from underlying diseases, neck tension, or unknown factors. Common causes can include damage to the spine, tumors, nerve damage caused by diabetes, swelling of the blood vessels, or infection.

The pain of occipital neuralgia is described as severe, with a burning or shooting sensation. It is typically on one side of the head and worsens with neck movement. Patients may also experience sensitivity to light.

Treatment options may include rest, massage, heat therapy, physical therapy, and the use of pain medication with anti-inflammatory properties. In more severe cases, medication like muscle relaxants, nerve block injections, steroid injections, and local anesthesia may be used. Rare cases may call for surgery to reduce pressure on the nerves or block pain impulses to this part of the body.

Exercise-Induced Headaches

Stressed physical activity can cause headaches, which typically begin immediately after stopping the exercise. These may feel like a throbbing pain on both sides of the head, which lasts from five minutes to two days. An exercise-induced headache can be an isolated event brought on by things like weightlifting, running, sexual intercourse, or even straining on the toilet.

Treatment may include taking painkillers prior to exercising, avoiding activities that trigger an event, maintaining a healthy and balanced diet, and getting sufficient sleep.

Cervicogenic Headache

Pain that comes from the neck but is felt in the head is known as a Cervicogenic headache. These commonly result from an injury like whiplash or a pinched nerve, though they can also be caused by a neck fracture, a sprain, or arthritis.

The pain from a Cervicogenic headache is often on only one side of the head, and the pain usually begins at the bottom of the skull, traveling up one side of the head. Neck stiffness and discomfort when turning the head is also common. Sneezing or coughing can worsen symptoms.

Treatment for these headaches involves treating the injury itself, often through chiropractic care and physical therapy, though more intervention may be needed for more serious injuries. Once the neck has regained strength and flexibility, the pain is typically relieved without lasting headaches or other symptoms.

Other Causes of Headaches

In addition to these specific headache types, there are some general risk factors and considerations that can help you understand what may be causing your symptoms.

Illness and Injury: Common illnesses like colds, fevers, and viral infections are likely to lead to headaches that can manifest in the back of the head. If you have had a fall or car accident that led to a blow to the head, this can also be an explanation for a headache and should be checked.

Stress: Emotional stress and depression can cause headache pain. These situations can also cause behaviors that lead to headaches, like alcohol use, skipping meals, and changes in sleeping patterns.

Environment: Many headaches are triggered by surrounding sensory input. Secondhand tobacco smoke and strong smells like household chemicals or perfumes are common examples. Certain foods and allergens may also be a trigger for some people. Stress, pollution, noise, lighting, and weather changes are also known to induce headaches in those prone to them, especially migraine headaches.

Genetics: A tendency to suffer from headaches, particularly migraine headaches, can run in families. Most children and teens who have migraines have other family members who experience them.

When to Seek Medical Care

Many types of headaches are common, and experiencing them occasionally or in response to a trigger is not cause for concern. However, any severe or recurrent pain is a sign you should seek medical care to rule out more severe causes and find ways to manage the pain.

You should always call your doctor if:

• Headache pain is severe or sudden
• Pain gets worse with time
• You experience personality changes or mood shifts
• You have a fever along with your headache
• You notice confusion or memory problems
• You feel sluggish
• Jaw pain, vision problems, or a sore scalp occur

Diagnosing the Cause of Headaches

Understanding the exact type of headache you are suffering from and the potential causes can help you to begin a treatment plan that reduces or eliminates your pain. The first step to finding this diagnosis is speaking with a doctor about your headaches. They will ask you about your symptoms- the more information you can provide, the better they will be able to understand your concerns. Anything you can share about what causes the headache, how they feel, what helps or worsens them, and family history will all be important.

Most of the time, diagnostic tests will not be a large part of finding the cause of your headaches. Unless they are caused by a visible and distinct injury or condition that would appear on scans, they will not provide much clarity. However, your doctor may order a CT scan or MRI to look for certain issues or to rule out underlying conditions. They may also perform basic neurological exams of your mental status, motor strength, vision, and reflexes to assess your overall nerve function.

One scan that may be used is an MRA, or magnetic resonance angiogram. This is similar to an MRI and is used to see blood vessels in the brain, which can highlight any factors restricting or increasing blood flow. These blockages may trigger headaches and, if they can be identified, can be addressed through medication and procedures like a nerve block. An MRA will usually be performed when other methods have not been successful in identifying a cause for headaches.

In the case of a secondary headache, treating the underlying issue is the focus, rather than the headaches themselves. But with a primary headache, understanding the type of headache can help you not only manage symptoms, but also understand the causes of the episodes so you can reduce or eliminate the number of headaches that occur.

Treating Headaches

The way you treat a headache will depend largely on the exact cause of the headache, any related condition, and your goals and prognosis. Headache treatment can generally be split into 4 categories:

• Rescue
• Prevention
• Lifestyle modifications
• Complementary medicine strategies

Rescue

When a headache is starting or has started, finding a way to manage the pain is known as rescue. This can be a combination of medication and other methods that either reduce symptoms or prevent them from worsening. For example, those who suffer from migraine headaches often find a cool, dark space where they can rest and avoid as much sensory input as possible. While this does not reverse the headache or eliminate pain, it addresses the sensitivity and pain that a migraine can cause and avoids anything that may worsen the condition.

Some patients do find that taking medication early can stop the headache from progressing. This can include over-the-counter options like NSAIDs or aspirin, as well as prescribed medications. Toradol is a self-administered injection that can treat acute headaches, and corticosteroids can also be used in some cases.

Rescue tactics may also involve trying to stop accompanying symptoms, like nausea. Triptans are commonly prescribed to those with migraine headaches to reduce nausea and vomiting during an episode.

Prevention

Preventing headaches can mean different things in different types of headaches. Avoiding known triggers can be a form of preventing headaches, as can treating underlying conditions that are known to cause headaches. It is important to understand these causes and triggers in order to create a plan that prevents headaches. This is often more successful than a rescue plan as it seeks to stop the headache from occurring, bypassing pain and other symptoms.

It can be helpful to keep a headache diary and track the duration and symptoms of each headache. When one happens, take note of what you did that day, what you ate, and anything unusual about the environment. Over time you can try to identify patterns that may contribute.

Lifestyle Modifications

Even where there is not a known underlying condition, many small lifestyle changes can make a big difference in terms of headaches. This can also be used as a process of elimination to help determine what does or doesn’t bring on a headache.

Some examples of lifestyle modification that can help with headaches include:

• Avoiding overuse of medication
• Getting enough sleep
• Sleeping in a neutral position
• Eating regular meals
• Engaging in regular physical activity
• Reducing stress
• Reducing or eliminating caffeine
• Moderating alcohol intake
• Quitting tobacco use
• Practice good posture
• Avoid screen time and use blue light glasses when on a screen
• Ensure you have the right prescription and use glasses or contacts as needed
• If you have long hair, avoiding tight ponytails or braids
• Drink plenty of water, especially before drinking alcohol
• Cut out caffeine and other substances slowly to avoid withdrawal

Complementary Medicine Strategies

While there is no single medical procedure that can help all headaches, a variety of treatments are available that may help address the root cause or relieve symptoms.

When the pain is caused by an injury or physical ailment, chiropractic care and physical therapy can be helpful. By ensuring the spine is aligned and the muscles in the neck are strong, these practices help to prevent pain and headache as a result of injury and weakness. This is especially applicable if something like whiplash is contributing to the pain.

Neurological treatment may also be necessary, especially in cases of damage like occipital neuralgia.

Treating the Back and Neck for Headache Pain

Not all headaches are related to the neck and spine, but they are often contributing factors. Ensuring that the spine, including the cervical spine, is properly aligned and able to do the important work of supporting the head is one way to avoid headaches. Physical therapy and consistent chiropractic adjustments can help ensure the neck is strong, your posture is optimized, and the body is able to fight off any additional health concerns that may contribute to headaches.

At AICA Orthopedics, our holistic team of experts is dedicated to ensuring you find relief. Physical therapists, chiropractors, neurologists, orthopedists, pain management specialists, and others will work together to identify any contributing factors and develop a personalized plan based on your needs and goals. Contact AICA Orthopedics today to schedule your first appointment and begin finding relief.