Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 


Reference Article:
A Dentist's View on Muscle Headaches

by Christopher R. Brown, D.D.S

Reproduced with permission: National Headache Foundation. Fall 1994, number 90, page 2. Author: Christopher R. Brown, D.D.S. Greensburg, Indiana.

 The headache almost never stops. It seems even the hairs on your head ache. Sometimes your eyes become so sensitive to light during these painful episodes that you have to wear sunglasses just to get by. The areas of the headache vary but several areas that consistently hurt are the back of the skull or head, and the neck. Various mediations help a little for a while, but it seems the best way to reduce the pain is to have someone rub the back of your head and neck.

Does this sound familiar? If so, then perhaps you should ask your doctor about occipital neuralgia.

Occipital neuralgia is a term used to describe a cycle of pain-spasm-pain originating from the suboccipital area (base) of the skull that often radiates to the back front and side of the head, as behind the eyes.


  1. Headache that is localized or following a "ram's horn" pattern on the side of the head, often starting in the upper neck or base of the skull. It can be one-sided or on both sides.
  2. Scalp that is tender to the touch, often hypersensitive. Even brushing your hair can be a painful experience.
  3. Pain at the base of the skull. Pressure on that area can either bring headache relief or increase the pressure or pain.
  4. Reduced ability to rotate or flex the neck.
  5. Shoulder pain.
  6. Pain or pressure behind the eyes. Eyes are very sensitive to light, especially when the headache is present.

 The occipital nerves are two pairs of nerves (the lesser and greater occipital nerves) that originate in the area of the second and third vertebrae of the neck. While most people's nerve roots originate in similar places on the spine, cadaver studies show a wide variety of differences between individuals as to the course of the nerves once they leave the spinal column. Often the nerves follow a curving course that passes through various muscles in the upperback, neck and head. These nerves supply areas of the skin along the base of the skull and partially behind the ear. While the occipital nerves to do not directly connect with structures within the skull and form a continuous neural network that can affect any given area through which any of the main nerves or their branch fibers pass.

Occipital neuralgia occurs more often in women than men. I t can have many causes. These causes include:

  1. Trauma (a direct blow or "whiplash" type of injury)
  2. Spinal column compression
  3. Nerve lesions
  4. Localized infections or inflammation
  5. Gout
  6. Diabetes
  7. Blood vessel inflammation
  8. HEAD FORWARD POSITION (Added by Edward Lichten, MD)

Commonly, the nerves are inflamed and sensitive because they are trapped within the muscles through which they pass. Muscle spasm and pain are often associated with nerve entrapment, which causes localized pain, spasms and muscle cramping.

Treatment of occipital neuralgia may involve oral medications that are designed to reduce inflammation and spasms [Ketoprofen and flexeril: EML suggests], localized therapeutic injections [trigger point injections], physical therapy, ice massage head, exercise or, on rare occasions, surgery.

Many medical conditions can show symptoms similar to those found with occipital neuralgia. The most important aspect of any treatment is to first have an accurate diagnosis. It is also important to communicate your medical history to the health care professional who is treating you so that the correct diagnosis and care can be given for your special needs.