Headache and Pain in the Back of the Head – Causes, Symptoms

How to Find a Cause of Pain in the Back of the Head?

You can suspect a cause of pain in the back of your head from the pain duration and characteristics, other symptoms and circumstances.

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A. NEWLY APPEARING headache in the back of the head
B. EPISODIC, SHORT-LASTING headache in the back of the head
C. CHRONIC, RECURRENT headache in the back of the head
D. CHRONIC, PERSISTENT headache in the back of the head

A. Newly Appearing Headache in the Back of the Head

Newly appearing pain in the back of the head, lasting from minutes to weeks, can result from:

1. Injury of the NECK MUSCLES, like strained or torn muscle tendon (like in whiplash). Symptoms:

  • Pain in the shoulder(s), upper back, neck or back of the head, aggravated by turning the head
  • Tender spots in the neck
  • Neck stiffness
  • Neck swelling (sometimes)

2. Injuries of the cervical SPINE (C1-C3 level), like herniated disc or broken vertebra. Symptoms:

  • Usually one-sided pain, tingling or numbness in the neck and back of the head, worse in certain body positions, like sitting or lying.  If the spinal nerves at C4 or lower level is affected, the same symptoms may appear in the shoulder or arm on the same side.
  • Back of the head is usually not especially tender to touch

3. Enlarged and painful LYMPH NODES on the back of the head due to:

  • Scalp infection
    • Staph infection: one or more tender and painful red bumps (up to an inch in size) with an opening on the top
  • Infection of the middle ear (otitis media) or mastoid (mastoiditis), common in small children, but also in adults.
    • Symptoms: pain in one or both ears and back of the head on the affected side, pulling at ear(s), fever, irritability, decreased hearing, sometimes ear discharge
  • Strep throat (streptococcal tonsillitis)
    • Symptoms: red and swollen tonsils, sore throat, fever, tender or swollen lymph nodes in the neck and behind the ears
  • Infectious mononucleosis, caused by Epstein-Barr virus (EBV)
    • Symptoms: enlarged lymph nodes in the neck, armpits and groin, sore throat, low grade fever, headache, fatigue; disease may last for a month or more
  • Rubella, a viral, usually childhood infection, now rare in US
    • Symptoms: mild fever, facial and chest rash, painful lymph nodes in the back of the head

4. SINUSITIS may cause pain in the back of the head, if inflammation spreads to the sphenoidal sinus (1). Symptoms may include:

  • Constant, pressure-like pain in the cheeks or front
  • Dull pain in the back of the head
  • Blocked nose, thick discharge, sometimes low grade fever (in bacterial sinusitis)
  • Itchy nose and eyes, clear discharge (in allergic sinusitis)

5. FOLLICULITIS – inflammation of the hair follicles. Symptoms:

  • Various bumps or lumps on the scalp or near the hair line

6. SHINGLES – HERPES ZOSTER – a reactivation of a Herpes zoster virus due to stress or disease. Symptoms:

  • Usually one-sided, burning neck and head pain or tingling
  • An itchy rash that follows the pain within a week or two

7. INFECTIOUS MENINGITIS (viral, bacterial, fungal) can spread from a skin, nose, mouth or ear infection or by droplet infection from another person. Symptoms include:

  • High fever
  • Severe headache starting at the back of the head, aggravated by bending the neck forward
  • Neck stiffness
  • Nausea and, often, vomiting
  • Sensitivity to light (photophobia)

8. Relatively rare causes of sudden, newly appearing pain in the back of the head

  • THUNDERCLAP HEADACHE, a sudden severe headache in the back of the head, reaching its peak in less than a minute. Causes include:
  • A headache PROGRESSING FROM A MILD TO SEVERE within hours or days can result from the same causes as a thunderclap headache (see above)
  • Primary THUNDERCLAP HEADACHE, a sudden, severe headache, like someone would hit you at the back of the head, can, rarely, appear without a known cause (3).

B. Episodic, Short-Lasting Headache in the Back of the Head

Recurrent head pain, lasting from minutes to few days and completely disappearing between attacks, can be triggered by:

1. HAIR ACCESSORIES, hats

2. STRESS (eye strain, bad posture), causing a pressure-like TENSION HEADACHE

3. Psychological or other factors, triggering a MIGRAINE with throbbing, pulsating pain

4. Rare causes of episodic, short-lasting pain in the back of the head

  • HIGH BLOOD PRESSURE, causing a throbbing pain in the back of the head or temples
  • MENSTRUATION in YOUNG WOMEN, causing BASILAR MIGRAINE. Symptoms are related to period and include various strange sensations (aura), followed by one or both-sided pain on the back of the head, and neurological symptoms: partial or complete loss of vision, poor muscle coordination, slurred speech, hearing problems and dizziness
  • SUDDEN TURNING OF THE HEAD can cause a NECK-TONGUE SYNDROME (2). An underlying disorder is usually a pinched nerve arising from C2 segment of the cervical spinal cord. Symptoms include: usually one-sided pain in the neck and back of the head and abnormal sensations on the same side of the tongue, triggered by sudden turning of the head; symptoms last for seconds or minutes.

C. Chronic Recurrent Headache in the Back of the Head

Headache lasting for months or years, aggravated by certain triggers can be due to:

1. Disorders of CERVICAL SPINE, like degenerative disc disease (DDD), bulging disc, spinal arthritis (spondylitis), systemic lupus erythematosus (SLE), stenosis of the spinal canal, resulting in OCCIPITAL NEURITIS or NEURALGIA. Symptoms:

  • Recurrent, stabbing pain and abnormal sensations in the back of the neck and head with or without persistent aches between painful periods
  • Back of the head tenderness

2. FIBROMYALGIA is a painful muscle condition of uncertain cause, more often in women. Symptoms include:

  • Chronic fatigue
  • Muscle and joint aches
  • Non-refreshing sleep
  • Pain triggering points on the back of the neck, chest, elbows, hips and knees

3. Chronic myofascial pain (CMP) resembles fibromyalgia. Symptoms include:

  • Deep aching pain in the back of the head, triggered by pressing on certain spots in the muscles on the back of the neck
  • Neck stiffness

4. Disorder of the temporomandibular (TMJ) joint. Symptoms:

  • Pain around the ear and on the back of the head, triggered by eating or speaking

5. SOMATISATION DISORDER: a psychological disorder with several physical complaints

6. Rare causes of recurrent pain in the back of the head

  • Inflammation of the ARTERIES of the skull (cranial arteritis), which includes temporal arteritis, occipital arteritis, Giant cell arteritis. Symptoms: severe, sometimes throbbing, usually one-sided head pain, tenderness (sometimes extreme), low-grade fever
  • POLYMYALGIA RHEUMATICA – a rheumatic inflammation of large muscles. Symptoms include stiffness and pain in the neck and shoulders
  • TORTICOLLIS or “WRY NECK”, congenital or acquired. Symptoms: twisted neck due to prolonged, painful muscle spasm in the neck
  • Some patients with MULTIPLE SCLEROSIS may experience shooting pain in the back of the neck and head, when they bend the neck forward.

D. Chronic Persistent Headache in the Back of the Head

Constant headache lasting from weeks to years, either newly appearing or lasting “from ever”, is pretty rare and can be due to:

1. BRAIN TUMOR or CYST (Echinococcus, Toxoplasma). Symptoms may include:

  • Neurological symptoms, like abnormal sensations or weakness, on one side of the body
  • Headache, worse in the morning, not responding to over-the-counter (OTC) painkillers

2. Enlarged and painful LYMPH NODES in the back of the head due to:

  • Pharyngeal cancer (in the throat). Symptoms may include: pain in the throat or ear, a lump or ulcer in the throat, a lump in the neck, difficulty swallowing (dysphagia), enlarged lymph nodes in the neck and back of the head
  • Other head or neck cancers
  • Leukemia or lymphoma. Symptoms: enlarged painful lymph nodes in the neck, armpits and groin, frequent infections, weight loss, low grade fever

3. Congenital disorders, which may cause headache and various neurological symptoms in childhood or later:

End Notes

If you experience an unexplained, newly appearing, constant, or severe pain, visit your doctor as soon as possible and do not try to find an answer online. It is not your job to make a self-diagnosis. It may greatly help to your doctor if you provide him your exact personal medical history, though.

Related Articles:

References:

  1. Sinusitis in sphenoidal sinus and pain in the back of the head  (mhni.com)
  2. Neck-tounge syndrome  (ncbi.nlm.nih.gov)
  3. Primary thunderclap headache  (ihs-classification.org)
About Jan Modric (249 Articles)
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  • farnaz

    i have headache every day and icant even sleep

  • Jan Modric

    farnaz,

    revealing age, sex, in which part of the head is the pain, onset of headache, eventual underlying diseases, medications..can help to identify the cause of a headache.

  • Andy

    For about the past year I often have a dull headache in the top of my neck/base of my skull. It always occurs during sleep, and during this time my sleep is broken, and non-refreshing. I’ve dealt with migraines all my life but I could mange those — these new headaches are making it hard to function as I am not getting proper sleep. I’m a male, 30 years old, and have seen a few doctors. I currently take Imitrex (25mg) for headaches, and it usually works, but I take it almost daily, which worries me. I’ve tried the likes of Verapamil, Propanolol, Prednisone – all to no avail. I would love it if I could get something preventative instead, as I can’t remember the last I had a good night’s sleep. Any help would be great. Thanks.

  • Jan Modric

    Andy,

    have you had a CT or MRI of your neck spine? A bulging/herniated disc can pinch the nerves that innervate the back of the neck and head. Such pain is position dependent. Treatment depends on the extent of the damage: physiotherapy or – surgery. Prevention would be in trying to find a good sleeping position, experimenting with shallow pillows.

  • chicku

    i have headache on back side of head and unable to sleep at night …

  • Jan Modric

    chicku,

    do you have also a pain in the neck? When did the pain start? Do you have any pain or tingling in the face or arms? How old are you, are you male or female?

  • Hyewon Kim

    Following symtoms for 8days and continuing with headaches getting worse and spreading with longer time frame:
    Happens when I stand up or leaning over.
    Severe headach back lower parts of head to the temples, severe pain at back of neck to between shoulders, flash of light onset, pain at the back of eyeballs, pains and numbness to both arms, shakey hands after with tingling sensation, feels cold, cold hands and feet, random pains to left arm ans chest,dizziness, nausea with puking… What could this be? My doc ded couple of blood tests and slotted me for stress heart test in the next couple pf days but ignored my headache saying” lets concentrate on your heart condition first”… But the headach is getting worse every day and lasts longer happening more often. Please help!

  • Hi Hyewon. The most serious conditions need to first be excluded. So your doctor is correct in his/her approach. First check if it is a heart condition. If this is not a heart condition, it is also important to look at other cardiovascular conditions which may lead to serious events like a stroke. While many of these symptoms could be attributed to certain types of headaches, including migraines, none of this is life threatening. It is advisable that you just follow up with your doctor. Do not skip any of these tests. Once a heart attack, stroke or other suspected condition with serious outcomes is excluded then look at other possibilities.

  • mel

    I have a swollen mass (for lack of a better word) in the back of my head, where the very top of my neck meets my skull..it is hard and doesnt move and it is not a certain shape..more like whatever it is is attached to something and hidden from touch. I noticed it almost 3 weeks ago. I have headaches that last most of the day every day. My left arm has gone numb at times. I have a pressure like almost swelling feeling through my head and neck 1 to several times a day. I’m very tired, sleeping more than normal with no relief. I was told a week ago I had a chronic sinus infection and chronic ear infections..I dont have any pain in ears and no pain in the swollen mass on back of my head. I have had cold/flu symptoms for 3 months. Im female, 27. What could this be?

  • Carlos

    I Have headache on back side of head, only when im standing up or sitting down, not when im laying down tho.

  • Hi Carlos. The neck muscles have to keep the head upright when you are upright and neck muscle spasm is one of the most common causes of headaches. These muscles can then relax when you are lying down. Of course certain cardiovascular conditions could also present in a similar way as the heart has to work harder when upright then when lying down but other symptoms would also have been present. See a doctor and if it is neck muscle spasm then you may also have to consult with a physical therapist.

  • Hi Mel. From what you say it could be an enlarged lymph node which would correlate with your chronic sinus/ear infections. The other symptoms are concerning and also raises the question of complications such as mastoiditis. You should be consulting with a doctor as it can become very serious in a short period of time without proper medical treatment.

  • paggs

    I woke up 2 days ago with the back left bottom of my skull tender and painful to touch or when I turn my head it feels like a bruise on my skull bone but i did not have any trauma and dont see anything there. It was not a strain from the way i slept as i slept normal and its directly on the bone. It doesnt hurt if its not touched or moved by turning my head. Its freaking me out and hurts to lay on my left side. Any clue what it could be. No other known med conditions im 38 yr old female.

  • Hi Paggs. Difficult to say for sure. It could be one of the tendons that attaches to this area which may be strained. But there are other possibilities like mastoiditis. It is advisable that you consult with your doctor. Hopefully it is nothing serious but the only way to know for sure is to have it assessed by a medical professional.

  • Bluefootdown

    I’m not sure for how long now but at least for a few weeks I have had a headache in the back of my head. it is not a sharp pain however it does become extremely intense. for me it is a very unique pain, it doesn’t feel like a normal ache. the base of my head feels numb and tingly when it aches, and the headaches usually start out fairly mild but after a while it gets worse. they last for a few minutes to a few hours depending on how painful they are. I find that I often can’t concentrate on work, and I have been feeling very tired lately. my sleep isn’t broken by my headaches or anything, however I do feel like I’m not sleeping enough, and am often drowsy. I’m sixteen, and female. I should mention also that although this type of headache has mainly occurred within the past month or so, I have experienced it before, (though I can’t remember a specific time it started). but it was so rare that I assumed I was just a bit under the weather. now it is happening several times a day and has become a massive concern. I’ve not been to the doctors yet and I always try not to take any painkillers unless the situation is critical.

  • Hi Bluefootdown. It is not advisable to leave a month long headache unattended. Most headaches are due to muscle strain, usually of the head, neck and upper back. You should see a doctor because sometimes headaches are due to other causes apart from muscle strain. It could be related to your menstrual cycle, anemia and so on which is common in your age group. This could even be migraines. The only way to know for sure is to consult with a doctor.

  • Daisy

    A week after my period (accompanied with unbalance vertigo symptoms and lightheadedness) I got a sore throat and inflamed sinuses.
    Then I had a horrible dull aching headache in the back of my head. My neck hurt as well. I ended up in the emergency because I would feel bad and my hands, feet would get numb and I would start trembling/shaking.
    Doc said it’s a virus and my head pain could be a sinus headache.
    The headache gradually subsided.
    Recently for 3 days every time I try to fall asleep, I wake up with my head feeling numb and tingly and sometimes my fingers and feet, even arm and leg would go numb/pins and needles.
    I tried a different position and slept through the whole night but now it still comes up. I can’t sleep at all on my belly.
    Is this due to the sinus inflammation? I have thick green mucus as well but a week ago my ct scan showed no thickening of mucus in sinuses.
    It seems to get worse when laying down.
    What can the head numbness be from?

  • Daisy

    First I had a week of unbalance feeling during the week of my period and college finals. It made me feel a bit lightheaded and faint as well
    Afterwards the vertigo went ago and I got a bad sore throat for 3 days and inflamed sinuses.
    Then my head in the back started hurting along with my neck. It was also a numb tingly dull achy sort of headache that was ongoing
    I ended up in the ER feeling unwell shaky, shivering, faint feeling and the doc said I have a virus and the headache could be a sinus headache. But last week the CT scan didn’t show thickening of the mucus.
    Now I have thick green mucus and a heavy feeling in throat.
    And for 3 days now every time I try to fall asleep I wake up and feel numbness pins and needle feeling in the back of my head. I couldn’t sleep for 2 days. Then I tried laying on my back in between two pillows and was able to sleep though I woke up a few times with the same feeling
    Sometimes my fingers, toes even arms and legs go numb.
    Usually it’s when lying down.
    The headache and neck pain have gradually subsided but the numbness when sleeping has not. It’s been 3 days now.
    Is this all caused by sinusitus? Or the virus?

  • Sharon Cox-Buck

    I have a headache that goes from the right to the left side on the back of my head. It’s lower on the base of my head. It has woken me in the middle of the night, to just start hurting during the day. Thought it was my pillow! Tried many pillows and even made myself one that I love! Still have that headache everyday! Everyone tells me it’s stress! I had a physical before this started and besides being tired all the time everything is good! This is driving me crazy!

  • Hi Sharon. Thee are a number of different causes of headaches as you can see from the article above. The headache you are describing may be linked to neck and upper back muscle spasm (yes, psychological stress is one possible cause as these muscles tense with stress) but it can also be linked to poor posture and a pinched nerve in the upper vertebrae (cervical vertebrae). These are some of the possible causes and there is no way of saying for sure without further diagnostic investigation. It may be advisable to consult with a specialist like a neurologist for further assessment.

  • Marco

    I just saw a bunch of posts about this where they stopped their headaches by cutting out all artificial sweeteners including mouthwash with saccharin in it. Trying it today.

  • jovelyn

    i felt pain on back of my head,this has been started last year but i just dont mind it,now it seems like hurting everytime and it bothered me a lot.actually my neck is painful too,the pain goes through my head.what shall i do?please helppppp..im worried now!