Occipital neuralgia is diagnosed clinically, from sharp shooting or electric pain in the back of the head following the occipital nerve, with tenderness over the nerve and often altered sensation in the scalp. A diagnostic nerve block can support it.
Occipital neuralgia is diagnosed clinically, from sharp shooting or electric pain in the back of the head following the occipital nerve, with tenderness over the nerve and often altered sensation in the scalp. A diagnostic nerve block can support it.
The pain is described as sharp, shooting, stabbing or electric rather than the dull ache of most headaches, and it travels from the base of the skull upward and forward over the back and side of the head, sometimes reaching behind the eye. It is usually one-sided. Attacks are brief but can recur frequently, and there is often a background aching between them. The scalp in that distribution may feel numb, oversensitive, or painful to light touch, and brushing the hair can be uncomfortable.
Pressing over the occipital nerve where it emerges near the base of the skull typically reproduces the pain and may send it shooting along the nerve's path, which is the most useful bedside sign. Altered sensation in the same distribution supports it. Neck movement may aggravate the symptoms. Examination also checks for a cervical spine contribution, since upper cervical joint problems can refer pain into the same area and are managed differently.
Other causes of pain at the back of the head need considering: cervicogenic headache arising from upper neck joints, cervical radiculopathy, and less commonly a structural lesion, which prompts imaging arranged externally. Migraine can also produce posterior pain and coexists in some people. A local anaesthetic block of the occipital nerve serves as both a diagnostic and therapeutic step: relief following the injection supports the diagnosis. Occipital nerve block is available within the practice.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: headache; National Institute of Neurological Disorders and Stroke; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.