pinching back of the head pain
by sweetpbo, May 14, 2010
I have been having on again off again pinching pain that happens mostly in the middle to the back of my skull region. Im not sure if it is because of how I sleep at night or if I wear too tight of hair elastics. I work with the mentally and physically disabled so maybe even that could cause me to have stressful head pains. I just want to make sure if I'm ok or if I really should see someone professional.
by Christopher R Newey, DOBlank, May 16, 2010
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.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

Pinching sensations in the back of the head is nonspecific for any particular type of headache, especially if there are no other features such as sensitivity to light or sound, nausea or vomiting, severe pain including pain in the neck/shoulders, or neurological findings such as vision changes and teary of eye.  

There are many types of headaches and causes of headaches. One type of headache is a stabbing headache. It is usually a stabbing pain confined to the head or face and can be very transient (<1sec) or longer (several minutes). It can be a one time stab or multiple stabs. Some people describe these pains as being stabbed by an ice pick. These headaches are unique in that they usually respond very well to indomethacin.

Another type of headache that can occur in the back of the head/neck is cervicogenic headache. This headache is referred pain from pain in bony structures of the neck/shoulders/back, muscles of these regions, and other soft tissues of these regions. Associated findings may include pain worsened with neck movement, pain worsened when pressure is applied, and/or decrease range of motion of the neck. Treatment for this headache type is physical therapy, behavioral therapy, and other modalities.

Occipital neuralgia is caused by irritation or injury to one or both of the 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.

Lastly, you may wish to find other ways to hold your hair back/up to see if the pain improves.

Without further information about your headache, it is difficult to provide you with adequate information. However, it is important for you to understand that if you have not experienced headaches in the past and you are now having new head pains, seeing a neurologist is a good idea, just to make sure there is nothing serious causing this pain. Imaging of the brain and sometimes then neck may be indicated depending on your exact symptoms, your physical examination, and other factors.

Thank you for using the forum, I hope you find this information useful, good luck.
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