Nerve Pain: Is It Different From a Headache?

Originally published September 13, 2017

Last updated April 23, 2024

Reading Time: 2 minutes

That nagging headache may not be a headache at all, but nerve pain caused by inflamed occipital nerves.

You have probably experienced a headache or even a migraine at some point in your life, but would you know the difference between a headache and nerve pain? Occipital neuralgia mimics the symptoms of a headache but is actually caused by inflamed occipital nerves.

What is the difference between occipital neuralgia and other headaches?

There are four categories of primary headaches:

  • Migraines affect 12% of the population of the United States. These throbbing headaches can last for hours and even go on for multiple days. In addition to pain, other symptoms include sensitivity to light and smells, nausea, dizziness and blurred vision.
  • Tension headaches, also known as sinus headaches, cause pressure and pain behind the eyes, cheekbones and bridge of the nose. They are accompanied by other sinus symptoms, such as a runny nose or blocked ears.
  • Cluster headaches are less common but are painful, intense headaches, with a burning sensation or piercing pain behind the eyes.
  • Trigeminal autonomic cephalalgias occur on one side of the head, near the trigeminal nerve. They usually include red and watering eyes.

If your headache pain isn’t described above, you may have occipital neuralgia. According to a study coauthored by Soma Sahai-Srivastava, MD, division chief of the USC Headache and Neuralgia Center at Keck Medicine of USC and clinical professor of neurology at the Keck School of Medicine of USC, if you have a migraine, you also should also be screened for occipital neuralgia, as the symptoms can be similar.

What is occipital neuralgia?

Occipital neuralgia is caused by trauma to or infection of the occipital nerves, oftentimes, because of a head injury or pinched nerve. The pain feels like a migraine, with burning and throbbing pain behind the eyes accompanied by shooting pain that starts at the base of the skull and radiates upward to the top of the head. At times the pain will appear on one side of the head.

How is occipital neuralgia diagnosed?

Your doctor will ask you about your medical history and any injuries to your neck or spine. A physical exam can determine whether pressure on the occipital nerve elicits pain. Other tests may include an MRI scan and an injection nerve blocker to see if there is any relief.

How is occipital neuralgia treated?

Treatment includes rest, massage and heat to the affected area and neck. Anti-inflammatory medications, such as muscle relaxers, can often relieve the symptoms. More aggressive treatments include occipital nerve blockers that provide instant relief with a few side effects, such as dizziness and lightheadedness.

If you have severe headaches, consult the experts at the USC Headache and Neuralgia Center at Keck Medicine.


Heidi Tyline King
Heidi Tyline King is a former magazine editor who has written for numerous national publications.