Back of the headache


Almost everyone has had a headache in their life. These can vary in strength as well as occur in different parts of the head. The experience of headaches is strongly influenced by the person affected, which is why now over 250 types of headache could be medically defined. In the majority of cases, the causes cannot be determined or are harmless. A more serious illness is rarely behind the pain symptoms that require competent treatment. So back of the headache usually has a harmless cause, but it can also be an indication of a more serious illness.

As with other locations, the pain is caused by the involvement of the components of the head that, in contrast to the brain, can feel pain. These are the cranial bones, the head muscles, the meninges, as well as the scalp and the localized vessels and nerves.


Fall injuries are an important cause of occipital headache. When falling to the ground, the back of the head often hits the lower surface, which can also leave injuries of various kinds with varying degrees of intensity. These range from a bruise (Hematoma), from a concussion to a traumatic brain injury with a cerebral hemorrhage or a fracture of the skull bone. If the pain does not improve after some time and emergency pain treatment, imaging diagnostics (computed tomography / CT, magnetic resonance imaging of the head / MRI) should definitely be carried out in order to rule out a serious injury. If the patient is better at first, but the headache recurs after a while, the fall may have resulted in cerebral haemorrhage (often epidural or subdural haemorrhage, rarely subarachnoid haemorrhage), which often requires surgical treatment.

Another cause of back headache is occipital neuralgia. This is a nerve pain caused by the three so-called Occipital nerves is triggered at the back of the head. These nerves feed the back of the skull and mediate the tenderness and pain in that area. The causes of occipital neuralgia are again diverse and range from muscle tension to gout and diabetes mellitus to space-consuming processes such as bleeding, inflammation or tumors.
A cervical vertebra syndrome (Cervical syndrome/ Acute cervical spine syndrome) and tension headaches can on the one hand be the triggers of occipital headaches themselves, on the other hand they can cause occipital neuralgia, which produces the pain symptoms. Both clinical pictures are often related to tension in the neck and occipital muscles. Changes in the cervical spine or permanent poor posture can also lead to corresponding symptoms.

A rare phenomenon is post-coital headache - headache that occurs after sexual intercourse. It can also be back of the headache, which is most likely to occur in men after intercourse due to the enormous amount of exertion. As soon as the exertion has subsided, the headache subsides again. Further diagnostic approaches should be initiated if the pain persists for a very long time or is of unusually severe intensity. There could be a problem with the heart or blood vessels that should be assessed by a doctor.

Read more on this topic at: Causes of headache

Cerebral haemorrhage, for example, is one of the serious causes of occipital headache. The most dangerous type is subarachnoid hemorrhage. Due to an injury or a ruptured aneurysm (vascular malformation / bulging), blood runs between the two inner meninges. The patient suddenly has severe headaches and the neck area often stiffens. Since such a cerebral hemorrhage can lead to serious consequential damage, an emergency doctor must be called immediately and the bleeding treated in a clinic.
Another disease that can cause headaches and stiff neck is meningitis (meningitis). However, a local limitation (pain only in the back of the head) is seldom found, but rather diffusely distributed pain.

Additional symptoms should also be taken seriously. If someone plagued by back headaches also reports dizziness, nausea or visual disturbances, these are alarming indications. You may have a concussion or more serious traumatic brain injury.

Read more on the subject at:

  • concussion
  • Traumatic brain injury

In rare cases, tumors can also be responsible for complex clinical pictures, with other causes occurring far more frequently.

Left back headache / Right back headache

Unilateral back of the headache can provide an indication of the localization of the cause. A special division between right and left is not possible because the anatomical structures are symmetrical. In the case of unilateral back of the headache, it is first necessary to find out what is causing the pain. Different types of headache often occur on one side and must therefore be ruled out diagnostically. These include migraine headache, cluster headache, and tension headache. Even simple muscular tension can, albeit atypically, occur on one side and be caused by poor posture.
A left or right back headache suggests a local cause that does not affect the entire head (as is the case with meningitis, for example). A mass can trigger the pain. This can be caused by a cerebral haemorrhage as well as a brain tumor, although the latter is much less common.

Back of the headache with nausea

As mentioned earlier Accidental injuries are often the cause of occipital headaches. In the event of a fall, the person concerned often lands with the back of their head on the floor. Although the brain is well protected in the cranial bones and in the nerve water, it will be affected in the event of a hard impact. It can lead to a concussion come, an easy one traumatic brain injury. The patient is mostly dazed and the functions of the brain can be restricted in various ways. The acute symptoms subside after a short time, but it can as a result, dizziness with nausea come. The body responds to the slight injury to the brain. So if headaches and nausea occur at the same time after a head injury, a medical observation is necessary.
This is often about a brief hospital stay regulated, in which the neurological functions are regularly checked. The point is to check whether there is a increased intracranial pressure trains.If the fall caused not only a concussion but a more severe traumatic brain injury, bleeding, water retention (edema) or entrapment (e.g. in the case of a skull fracture) can lead to an increase in intracranial pressure. Classic symptoms of this increase in pressure are nausea and vomiting. If the pressure rises too high, the brain can become trapped in existing anatomical structures, which is life-threatening.

Back of the headache when lying down

If the back of the headache only occurs when lying down, this can narrow down the cause of the problem. For example a muscular cause could be in the foreground. Many people suffer from permanent bad posture, which is often caused by the job (where you sit a lot, for example) and is retained. The unnatural posture causes the muscles to cramp. Most of them lack strong enough muscles to compensate for the permanent bad posture. Resulting Back or neck pain can continue into the muscles of the occiput. A few strands of muscle in the back attach to this bony structure, which then causes pain for those affected - the back of the head. Since you are moving and distracted throughout the day, the pain only really comes to the fore when the body is at rest and, for example, you lie down relaxed.

Headache at the back of a cold

Headaches come in various forms as a side effect of a cold. While initially only the nose runny and the throat scratches, a viral infection with rhino, corona or adenoviruses often leads to headache and body aches after a few days. Such headaches can also occur with other causes of illness that cause inflammation of the nasal mucous membrane and the paranasal sinuses. They occur primarily in the forehead region, but can also pull across the skull to the back of the head. However, there is no special "cold headache" - it can vary from patient to patient.
The mechanism underlying the headache is probably as follows: The inflammation of the nasal mucosa and sinuses causes a change in pressure in the airways. The inflammatory secretion cannot drain off sufficiently and leads to painful congestion. However, the process is usually harmless and is normally regulated by the body's own immune system. Another theory is that the headache is a reaction of the body to certain proteins (Cytokines) that are always produced when the immune system is confronted with a viral infection.

Read more on this topic at: Headache with a cold

Back of the headache during pregnancy

Extensive changes in the body and hormonal balance take place during pregnancy. The expectant mother has to adjust to the new situation, which in the rarest of cases goes completely smoothly. The back of the headache is particularly common in pregnant women. The headaches have different backgrounds and are caused by different circumstances. Among other things, the posture changes, which can lead to back pain with involvement of the neck and occiput. The nausea during pregnancy and the associated vomiting can aggravate a subliminal headache, which is due to the pressure increase in the head when choking. The change in diet and not having coffee in the morning can also be reflected in headaches.
Due to the various processes in the expectant mother's body, the sleep rhythm also changes. Without enough rest, otherwise healthy people develop headaches over a longer period of time. During pregnancy it is in the interests of the unborn child not to use medication to relieve headaches. Drinking enough water, getting enough rest, soothing massages and a balanced diet can work wonders.

Read more about this under Headache in pregnancy

Headache at the back of the flu

The flu is in contrast to a flu-like infection or a cold triggered by the influenza viruses. Many different symptoms occur in more or fewer patients, however Headache is one of the most common signs. Around 60% of all patients who have had the flu say they have had a headache. It is a classic general symptom, which in most cases begins before specific symptoms (such as coughing or runny nose). The "flu headache" can present itself as a holistic headache, as a front or back headache, is usually described as pressing or boring and can appear in varying degrees.
In the case of the flu, too, the process by which the headache occurs takes place in the airways. Through the Inflammation of the nose, sinuses and throat more secretion is produced, which cannot flow away due to the swelling and is blocked. The resulting increase in pressure irritates the local nerves and creates a headache. Various substances that are released when the immune system is activated to defend themselves against the viruses can also lead to corresponding headaches. Back headache in the context of the flu is a standard symptom, which mostly harmless is. However, if the headache is unbearable, if there is nausea or fainting, or if the person concerned no longer reacts to being spoken to, a doctor should be consulted urgently so that meningitis can be ruled out.

Pulsating back of the headache

Pulsating back of the headache indicates a vascular cause. Since the pain occurs with the pulse, it is reasonable to assume that a vessel at the moment of its strongest filling (during the pulse) which causes pain. For example, a Aneurysm, a vascular bulge, which irritates a nearby nerve every time it is filled. On the other hand, a nerve that is close to a pulsating vessel can become inflamed. This may lead to neuritis (Nerve inflammation) and in the course of neuralgia (nerve pain). An example of this is occipital neuralgia, which mainly causes back headache and can be triggered in this way.

Also the Pain associated with migraines is described as pulsating. Incorrect nerve stimulation of the blood vessels in the head causes them to become inflamed. As a result of the inflammation, the vessels widen and the headache sets in. Pulsating headaches usually get worse when the head is shifted downward than e.g. when stooping.

Sharp back of the headache

Sharp back of the headache is an alarming sign, especially if it occurs suddenly. A Subarachnoid hemorrhage, bleeding between the two inner meninges, leads to a sharp headache that can suddenly appear anywhere on the head. The pain is often given by patients as the strongest possible, which is why it is named "Annihilation Headache" owns. In the event of a sharp, sudden onset, severe headache, a doctor should be consulted immediately and directly. If there really is a subarachnoid hemorrhage, action must be taken as soon as possible to prevent permanent damage. This often requires an operative approach.

Back of the headache when laughing

Back of the headache that occurs when laughing is extremely stressful for those affected. Funny situations are permanently associated with pain and avoided in the future. A rare cause can be an existing one Migraine disease be. Laughing triggers a migraine attack, which is likely caused by the increase in pressure, movements and other complex processes in the brain. Specific treatment for migraines can help.
Another possibility is one tension-related headache. Various muscles of the back and neck attach to the occiput. Many muscles of the face, but also of the holding apparatus of the head, are used during exuberant laughter. If there is already tension or a headache, active laughter can lead to headaches or worsening of the symptoms. Another factor is the increase in pressure, which puts additional stress on the nerves and vessels in the skull.

Diagnostics and therapy

Before therapeutic steps to treat occipital headache are initiated, the treating doctor must find out the cause of the symptoms.
Massages and heat therapy can provide relief for tension. Sufficient physical activity also loosens the muscles and prevents tension-related headaches. The patient can learn various relaxation techniques (autogenic training), which he can use independently at home. Drug therapy for the headache is often not necessary.

Another factor that is often underestimated is drinking enough. If too little fluid is supplied to the body, the blood thickens and oxygen transport can no longer run smoothly. The nerve cells in the brain are no longer optimally supplied with oxygen, which can cause headaches.

An X-ray or CT image can be taken to rule out damage to the cervical spine. If there is a defect here, either guided physiotherapy or, in the worst case, surgical correction should be used. A CT examination can also clarify whether a tumor or another space-occupying process is responsible for the occiput.

When treating occipital headache with medication, a doctor should first be contacted. Taking pain pills can be harmful to your health without knowing the correct dosage. Regular use of certain pain medication also carries the risk of developing tolerance and dependency. Adults can usually take ibuprofen (400 mg), aspirin (500 mg), or paracetamol (500 mg) for headaches. However, any contraindications must be ruled out. For people with liver or kidney disease, as well as for children, different dosages apply, which must be discussed with a doctor.

Also read: Headache therapy