What is occipital neuralgia?
The greater occipital nerve, also called Arnold's nerve, leaves the spine at the top of the neck and runs up under the scalp towards the top of the head. When this nerve, or a neighbouring nerve, is irritated, it can cause a typical pain: doctors call it occipital neuralgia, or Arnold's neuralgia.
The international headache classification (ICHD-3), the reference doctors use to classify headaches, describes it as pain that comes in attacks, on one side or both, at the back of the head, along the path of these nerves. Often no precise cause is found. Neck tension, holding one position for a long time, a knock or wear in the neck are often mentioned: your doctor's role is to check that no other condition explains the pain.
It is a nerve pain: to understand this type of pain better, read Neuropathic pain: recognising nerve pain. For care options, see our Neck pain and Neuropathic pain pages. This article focuses on symptoms and daily life.
Occipital neuralgia: what are the symptoms?
According to this classification, the pain:
- comes back in attacks lasting from a few seconds to a few minutes;
- is severe;
- is shooting, stabbing or like an electric shock.
It comes with an unusual sensitivity of the scalp: brushing your hair, touching it or resting your head on the pillow can trigger an unpleasant or painful feeling. Pressure at the base of the skull, where the nerve emerges, is often tender. The area may also feel less sensitive than usual.
Between attacks, a dull ache in the neck may remain. Tiredness and fear of the next attack weigh on sleep and concentration. These effects matter as much as the pain and deserve attention.
Occipital neuralgia, tension headache or something else?
A tension headache feels like tightening or pressure, often on both sides, without shocks. Migraine throbs and often comes with nausea and sensitivity to light. Neck osteoarthritis can also cause headaches that start at the back of the neck. These pains sometimes coexist: a medical examination sorts them out.
According to the Swiss Headache Society, the diagnosis rests on a detailed conversation and an examination of the nerves (strength, sensation, reflexes). For head neuralgias, its recommendations include an MRI to rule out another cause. Your doctor may also suggest an injection of local anaesthetic around the nerve: if it temporarily relieves the pain, this helps confirm that the occipital nerve is the source.
Occipital neuralgia: what to do day to day?
Ease the load on your neck. Avoid keeping your head bent over a screen or phone for long periods. Place your screen at eye level and take regular breaks to move your shoulders and neck.
Move gently. Slow neck movements, without forcing, keep it mobile. A physiotherapist can suggest suitable exercises and teach you to relax the muscles at the base of the skull.
Sleep. A low, firm pillow that keeps your head in line with your body avoids pressing on the back of the head. If the pillow itself triggers the pain, try softer support under the neck.
Spot your triggers. For a few weeks, note attacks, positions, stress and sleep: these notes help your doctor and your therapist.
Medicines. Discuss them with your doctor. If you take painkillers several days a week, talk to your doctor: taken too often, they can themselves keep headaches going.
Warning signs: when to seek help without delay
The Swiss Headache Society lists signs that should prompt a search for another cause.
Go to the emergency department immediately if you have:
- a sudden, very severe headache;
- fever with a stiff neck;
- paralysis, numbness, or problems with vision, balance or speech;
- confusion or a seizure;
- a headache after a blow to the head.
See your doctor soon if:
- it is a new headache, or its nature changes;
- the pain is getting worse over the weeks;
- the pain changes a lot with position, lying down or standing;
- you have a history of cancer and this headache is new.
These lists are here so nothing is missed, not to worry you: according to the Swiss Headache Society, a serious illness is rarely the cause of headaches. If one of these signs appears, it simply needs to be checked without delay.
Looking beyond the nerve
The first consultation lasts 1.5 to 2 hours (CHF 182). Bring your medical file, your test results (MRI, reports) and the list of your medications. We review your situation and build your plan together. Follow-up is then adapted to your progress. We work alongside your GP and the other professionals who follow you, including your neurologist or physiotherapist.
Which approaches can play a part at Centre Algos?
Depending on your situation, several approaches can be combined, alongside your medical follow-up:
- Naturopathy: sleep, stress, diet and daily rhythm, to work on the habits that can influence pain.
- Cupping: applied to the shoulders and upper back, it can help release muscle tension around the neck.
- Breathing and cold: breathing exercises to help manage stress and tension. Cold exposure is only considered if it suits you and does not trigger attacks.
- Percutaneous hydrotomy: micro-injections under the skin. After assessment, when no warning signs are present and in agreement with your medical care, it can be discussed as a complementary option; it can bring relief, with no guaranteed result. We explain how it works, its limits and its contraindications; results vary from person to person. If hydrotomy is part of your plan, price on quotation, set at the first consultation according to your situation.
Everyone responds differently: the aim is to help you live your days better, without promising a result.
When to seek advice
What happens in your case
This text gives general guidance. What keeps your attacks going, in your particular daily life, deserves a real conversation rather than a generic answer.
A question before you decide? Book a free 10-minute call to see whether our approach suits you.
