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.

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
  • Scalp ringworm: itchy scalp, flaky, patchy rash
  • 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:
  • BRAIN ANEURYSM – a widening of one of the brain arteries
  • Bleeding between the brain and membranes covering the brain (subarachnoid hemorrhage), usualy from a RUPTURED ANEURYSM. Symptoms may include headache, neck stiffness, nausea, vomiting, unconsciousness
  • DISSECTION of the vertebral artery, usually after a head injury (like in bungee jumping), may result in severe headache in the back of the head, resulting in problems with speech, imbalance and other neurological symptoms
  • BRAIN TUMOR OR CYST
• 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:

• SYRINGOMYELIA – a cyst within the cervical spinal cord.
• CHIARI MALFORMATION – a herniation of the little brain.
  

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:

• Headache Causes
• Headache Types
• Causes of Head Pain
• Sudden Severe Headache
• Can Allergy Cause Headache?
• Constipation and Headache

References:

1. Neck-tounge syndrome  (ncbi.nlm.nih.gov)
2. Primary thunderclap headache  (ihs-classification.org)