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Neurology (Expert Forum)
head pain in the back of head
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
head pain in the back of head
by aprilprice, Nov 13, 2008 08:46AM
hey for about a week i been having bad pain on the back of the head and down were the neck meets, I also have tmj and that was acting up so i thought that maybe it was from that then the jaw got better and i was still having the pain so went to dr for maybe having a sinus infection and got medicine i still am on it it was geting a little better then this morning i pick my 4 yr old up and it hurt that area again and now i have that headache pain that i start with a again. any help with what it sounds like is going on thanks
aprilprice
aprilprice
Doctor's Answer
by Lama Chahine, MD, Nov 16, 2008 05:04PM
, Nov 16, 2008 05:04PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
It sounds like you are having head and neck pain. There are many potential causes to your pain, and without the ability to examine you and obtain a history, I can not provide you with a diagnosis, however, I will try to provide you with information regarding some potential causes.
Most people attribute headaches to sinus pain. The fact is however that sinus problems are not commonly associated with headaches unless there is associated purlulent nasal discharge and fever.
There are several causes of headaches. Headaches can be divided into primary and secondary. Primary headache disorders are headaches without a direct cause. Secondary headache disorders are due to an underlying problem, such as a tumor, medication side effects, central nervous system infections, clots in the veins in the brain, low CSF pressure after a spinal tap etc. The important thing to remember is that if you are not one to get headaches, you generally never or rarely got headaches then suddenly began experiencing one, it is always important to undergo an evaluation to make sure there is nothing serious going on.
There are several primary headache disorders, over 50 different types. For example migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type is cluster headaches, which are sharp pains that occur around and behind the eye often at night and are associated with tearing of the eye and running of the nose. And so on
Inflammation or arthritis of the temporo-mandiublar joint, commonly called the TMJ, can cause headache and temple pain. This can sometimes occur due to bruxism, biting down at night or during the day, and other stresses to the joint. This is best diagnosed/managed by an orthodontist or an ENT, and treatment includes braces and other dental fixtures and sometimes muscle relaxants, depending on the exact cause.
The causes of neck pain could generally be divided into muscular problems and spine problems. Problems in the neck muscles could be related to a sprained muscle, which often results from sudden movements, incorrect postures, etc. Problems in the spine could be related to problems in the bones of the spine which are called vertebra, most commonly arthritis. Other spine problems occur when the tissue between the vertebra slips out, what is called a herniated disc. Problems within the spinal cord itself can also lead to neck pain. The best way to evaluate this is with an MRI of the cervical spine.
Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.
Occipital neuralgia is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.
A concerning cause of neck pain associated with headache is a dissection: a small tear in the blood vessels that travel up the neck to the brain. This can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke.
If you are older than the age of 55, one potential causes is called giant cell arteritis or temporal arteritis. This is due to an inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out as it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.
As you can see from the discussion above, there are many potential causes to your symptoms, some of which are more serious than others. It would be a good idea to discuss your symptoms with your primary care/family physician. He/she can obtain a history and examine you and based on that determine whether or not your symptoms are muscular, neurologic, or otherwise, and order further testing or refer you to a specialist.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
It sounds like you are having head and neck pain. There are many potential causes to your pain, and without the ability to examine you and obtain a history, I can not provide you with a diagnosis, however, I will try to provide you with information regarding some potential causes.
Most people attribute headaches to sinus pain. The fact is however that sinus problems are not commonly associated with headaches unless there is associated purlulent nasal discharge and fever.
There are several causes of headaches. Headaches can be divided into primary and secondary. Primary headache disorders are headaches without a direct cause. Secondary headache disorders are due to an underlying problem, such as a tumor, medication side effects, central nervous system infections, clots in the veins in the brain, low CSF pressure after a spinal tap etc. The important thing to remember is that if you are not one to get headaches, you generally never or rarely got headaches then suddenly began experiencing one, it is always important to undergo an evaluation to make sure there is nothing serious going on.
There are several primary headache disorders, over 50 different types. For example migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type is cluster headaches, which are sharp pains that occur around and behind the eye often at night and are associated with tearing of the eye and running of the nose. And so on
Inflammation or arthritis of the temporo-mandiublar joint, commonly called the TMJ, can cause headache and temple pain. This can sometimes occur due to bruxism, biting down at night or during the day, and other stresses to the joint. This is best diagnosed/managed by an orthodontist or an ENT, and treatment includes braces and other dental fixtures and sometimes muscle relaxants, depending on the exact cause.
The causes of neck pain could generally be divided into muscular problems and spine problems. Problems in the neck muscles could be related to a sprained muscle, which often results from sudden movements, incorrect postures, etc. Problems in the spine could be related to problems in the bones of the spine which are called vertebra, most commonly arthritis. Other spine problems occur when the tissue between the vertebra slips out, what is called a herniated disc. Problems within the spinal cord itself can also lead to neck pain. The best way to evaluate this is with an MRI of the cervical spine.
Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.
Occipital neuralgia is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.
A concerning cause of neck pain associated with headache is a dissection: a small tear in the blood vessels that travel up the neck to the brain. This can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke.
If you are older than the age of 55, one potential causes is called giant cell arteritis or temporal arteritis. This is due to an inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out as it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.
As you can see from the discussion above, there are many potential causes to your symptoms, some of which are more serious than others. It would be a good idea to discuss your symptoms with your primary care/family physician. He/she can obtain a history and examine you and based on that determine whether or not your symptoms are muscular, neurologic, or otherwise, and order further testing or refer you to a specialist.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Member Comments (2)
by CspineMess, Nov 15, 2008 09:50PM
To: aprilprice
I have severe headaches in the back of my skull and behind my right ear. These are called occipital neuralgias or cervico-genic headaches and result from a nerve in the upper vertebrae of the spine. My comes from C2 and my doctor is recommending a C2 RF nerve block to severe the nerve and stop the pain. My headaches are so severe that they make me vomit. The procedure is supposed to bring relief but is also temporary as the nerver will eventually regenerate itself. It can bring from 6 months to 2 years of relief with an average of 9 months. I have found that wearing a soft cervical collar to hold up my neck brings some relief.
