Headache at the Back of the Head: Causes, When to Worry, Treatment

Headache at the Back of the Head — Causes, When to Worry and Treatment

What usually causes pain at the back of the head or the base of the skull, the warning signs that need urgent care, and what helps. Explained by a Sydney neurologist.

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When a Headache at the Back of the Head Needs Urgent Care

Most headaches at the back of the head are not dangerous. A few patterns need care straight away, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely and reaches its worst within a minute (the worst headache of your life), even if it then eases
the headache comes with fever and a stiff neck, a rash that does not fade when pressed, confusion or unusual drowsiness
the headache, or sudden neck pain, comes with sudden severe dizziness or unsteadiness, trouble walking, double vision, slurred speech, a drooping eyelid, or numbness or weakness of the face, an arm or a leg
the headache started after a head injury and is getting worse, comes with vomiting, drowsiness or confusion, or you take blood-thinning medicine
the headache comes with a seizure, loss of vision (even if brief) or difficulty speaking
a very high blood pressure reading (a top number of 180 or more, or a bottom number of 120 or more) comes with chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure: call 000 straight away
your blood pressure is still very high when you measure it again after 5 minutes of sitting quietly, and you have a headache
you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have a severe headache, a headache that does not get better with simple pain relief, blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, vomiting with a headache, or a reading of 160/110 or more: go to your maternity unit or an emergency department now; call 000 for a seizure, trouble breathing or chest pain
you have a spinal cord injury at mid-chest level or higher and get a sudden, pounding headache, often with sweating or flushing above the injury: sit upright with your legs down, loosen anything tight, check your bladder, catheter and bowel, and follow your own dysreflexia plan if you have one; call 000 if it does not settle within a few minutes or you cannot find the cause

A sudden, explosive headache, wherever it is felt, can mean bleeding around the brain (a subarachnoid haemorrhage). A very high reading with chest or back pain or shortness of breath can mean the heart or the main artery from the heart is under strain; with vomiting, problems with eyesight, confusion or a seizure, it can mean the pressure is affecting the brain (hypertensive encephalopathy). A very high reading with a headache needs checking in an emergency department, because only tests can show whether the pressure is harming the brain, heart, eyes or kidneys. In pregnancy or after a birth, a severe headache can be the first sign of pre-eclampsia, a condition of high blood pressure in pregnancy; after a spinal cord injury, a pounding headache can be autonomic dysreflexia, a sudden surge in blood pressure set off by something below the injury, such as a full bladder. In both, lower readings than 180/120 count: in pregnancy, 140/90 is high and 160/110 is severe; after a spinal cord injury, a rise in the top number of 20 to 40 or more above your usual reading matters, and 130/90 can already be high. Dizziness, weakness or trouble speaking can mean a stroke; with sudden neck pain, a tear in the wall of an artery in the neck (a dissection), which can lead to one. Fever with a stiff neck can mean meningitis. A seizure with a headache needs urgent checks for a cause in the brain. All need urgent treatment. If you have migraine, your usual aura (shimmering or zigzag lines that spread slowly over several minutes and clear within an hour) does not need 000 on its own. A first attack, one that is different, or one that comes with a very high reading needs urgent care. In the same way, vomiting in your usual migraine attack does not need 000 on its own; with a very high reading, it does. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

it is a new headache and you are over 50, especially with a tender scalp, pain in the jaw when you chew, or feeling generally unwell
the headache is getting steadily worse over days or weeks, or is worst on waking, with vomiting
the headache is brought on by coughing, sneezing, laughing or straining
the headache is worse when you sit or stand up and eases when you lie down
there is new, severe pain on one side of the neck and the back of the head, especially after a neck injury, a strain or neck manipulation
your blood pressure is still very high (a top number of 180 or more, or a bottom number of 120 or more) when you measure it again, even if the headache has gone and you feel well
you have a fever with the headache
you have cancer or a weakened immune system
you are pregnant or have had a baby in the last 6 weeks, or a reading taken from 20 weeks of pregnancy to 6 weeks after the birth is 140/90 or more: contact your midwife, maternity unit or GP the same day; with blurred vision or sudden swelling of the face, hands or feet, contact your maternity unit or go to hospital now

A very high reading without symptoms is rarely an emergency, but it needs a doctor that day to start or adjust treatment. If you cannot see your GP that day, go to an emergency department. If the headache started after a lumbar puncture, a spinal anaesthetic or an epidural, contact the hospital that did it. If something matches both lists, follow the 000 list.

Where most people sit

These patterns are uncommon. Most headaches at the back of the head are tension-type headache, migraine or a headache coming from the neck: common conditions that do not damage the brain and can be treated. If you are worried about a brain tumour: in a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have one, and tumours usually cause other symptoms too, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks.

Why Does the Back of My Head Hurt?

Many people expect pain at the back of the head to mean a problem at the base of the brain, or that their blood pressure is up. Usually it is neither. Long-standing high blood pressure rarely causes headache; a sudden, very high rise can. The most common causes are tension-type headache, migraine and the neck itself. So why is the back of the head such a common place to feel pain?

The answer is in the wiring. The scalp and muscles at the back of the head are supplied by nerves from the top of the neck (the occipital nerves). Those nerves feed into the same relay station, in the brainstem and the top of the spinal cord, as the main nerve of the face and forehead (the trigeminal nerve), a meeting point doctors call the trigeminocervical complex. It is a little like two phone lines sharing one switchboard: the brain cannot always tell which line a signal came in on. So pain that starts in the neck can be felt in the head, and a migraine can be felt in the neck and the back of the head.

That is why a long day at a laptop, a stiff neck after a bad night's sleep and the start of a migraine can all show up in the same place.

Where most people sit

Most headaches at the back of the head come from the muscles, nerves and joints of the neck, or from migraine. They can be painful and they can keep coming back, but they do not damage the brain, and most improve once the cause is clear.

The Common Causes of a Headache at the Back of the Head

Each of these has a typical pattern. No single feature proves one, but together they point to it.

Tension-type headache. The most common headache of all: in different studies, between 30% and 78% of people have had one. It feels like pressure or tightening, like a tight band or a weight, usually on both sides, and often across the back of the head and the neck. It is mild to moderate, does not throb, and you can usually carry on with your day. Stress, tiredness, poor sleep and long hours at a desk make it more likely, and the muscles of the scalp and neck are often tender.
Migraine. Migraine is often thought of as a pain at the temple, but it can sit at the back of the head and in the neck. Neck pain is common during attacks: in one US study it was more common than nausea. Migraine is usually throbbing, moderate to severe and worse with activity, and comes with nausea or a dislike of light and noise.
Cervicogenic headache, a headache coming from the neck. It starts in the neck or at the base of the skull and spreads forward, usually on one side, always the same side. Certain neck movements, or holding the head in one position (reading, driving, a laptop), bring it on. Read more about cervicogenic headache, and about headaches that stay on one side.
Occipital neuralgia. Irritation of the occipital nerves causes severe, sharp, shooting or stabbing pains that run from the base of the skull up over the back of the head and last from a few seconds to minutes. The scalp can feel numb, tingly or sore, so brushing your hair or resting your head on a pillow can hurt, and the nerve is tender where it leaves the base of the skull.

Tension-Type Headache, Migraine, the Neck or a Nerve?

These features help tell the four common causes apart.

Swipe the table sideways to compare all four →

Feature	Tension-type headache	Migraine	Cervicogenic headache	Occipital neuralgia
Side	Both sides	Often one side, but can switch sides or affect both	One side, always the same	One side or both
Where it starts	A band around the head, or the back of the head and the neck	Often the temple or behind the eye; neck pain is common	Neck or base of the skull, spreading forward	Base of the skull, shooting up over the back of the scalp
Feels like	Pressing or tightening, mild to moderate	Throbbing or pulsing, moderate to severe	A steady, non-throbbing ache	Sharp, shooting or stabbing, in attacks lasting seconds to minutes
Brought on by	Stress, tiredness, poor sleep	Sleep loss, missed meals, hormonal changes, the let-down after stress, alcohol	Neck movement, sustained postures, pressure on the neck	Pressure on the nerve at the base of the skull
Other symptoms	Usually none; no more than mild nausea	Nausea, sensitivity to light and noise; sometimes aura	Stiff neck; sometimes a shoulder or arm ache	A numb, tingly or sore scalp

A headache set off within a second or two of coughing, sneezing, laughing or straining is a different condition (cough headache). It peaks almost at once and usually fades over seconds to minutes. About 4 in 10 cough headaches have an underlying cause, most often a Chiari malformation, where the lowest part of the brain sits lower than usual and crowds the top of the spinal canal. So a cough headache is always worth having checked, usually with an MRI scan. Headaches that come on with hard exercise or during sex are assessed with the same care: see headache after exercise.

Where most people sit

The table is a guide, not a diagnosis. The features overlap, and many people have more than one kind of headache: tension-type headache and neck pain are both common in people with migraine. All four are treatable, and sorting them out is the main job of the consultation.

The Less Common Causes Doctors Look For

A few other conditions can cause pain at the back of the head. Each is uncommon, and each usually has a pattern that gives it away.

Low pressure of the fluid around the brain (low cerebrospinal fluid pressure). A headache, often with a stiff neck, that comes on soon after you sit or stand up and eases when you lie down. The most common cause is a leak after a lumbar puncture, a spinal anaesthetic or, occasionally, an epidural (a post-dural puncture headache, often called a "spinal headache"). It starts within five days and usually settles on its own within two weeks; if it does not, the leak can be sealed with a small injection of your own blood (an epidural blood patch). Rarely, a leak happens without any procedure (spontaneous intracranial hypotension). Read more about headache when standing up and the blood patch.
Raised pressure inside the head. A headache that is worse lying down or first thing in the morning, sometimes with vomiting or blurred vision, and that gets steadily worse, can mean pressure is building up, for example from a blockage of the fluid pathways or, rarely, a tumour. It needs prompt assessment and a scan.
Giant cell arteritis, an inflammation of the arteries of the scalp. A new headache after 50, often at the temples but sometimes at the back of the head, with a tender scalp, pain in the jaw when chewing and feeling unwell. It is treated urgently to protect the eyesight.
A tear in an artery in the neck (vertebral artery dissection). New pain at the back of the neck and head, usually on one side, sometimes after a neck strain or injury, which can be followed by dizziness, unsteadiness or other stroke symptoms.
Very high blood pressure. Long-standing high blood pressure rarely causes headache. A sudden, very high rise (a top number of 180 or more, or a bottom number of 120 or more) can: if the reading is still that high after 5 minutes of sitting quietly and you have a headache, go to an emergency department or call 000; call 000 straight away if you also have chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. In pregnancy, after a birth and after a spinal cord injury, lower readings count: see the lists at the top, and headache with high blood pressure.

In children, headache mainly at the back of the head is uncommon, so a child with this pattern should always see their GP.

Where most people sit

These causes are uncommon, and they usually announce themselves: a headache that changes with posture, worsens week by week, comes with stroke symptoms, or starts after 50. A careful history and examination usually tell the doctor whether any of them is possible, and the right test, when one is needed (a scan, blood tests or an eye check), usually settles the question.

How Is the Cause Found?

Most of the time the cause is found from your story and an examination. Tests are for when the pattern raises a question.

Your story. Where the pain starts and spreads, what it feels like, how long it lasts, what brings it on (posture, coughing, exercise, a long day at a desk), what eases it, how often you take pain relief, and any other symptoms.
The examination. A full neurological examination, including the back of the eyes, your blood pressure, how your neck moves, and tenderness over the muscles and the occipital nerves.
A scan, when it will change what happens next. An MRI scan is the usual test when the pattern points away from the common causes, for example a headache brought on by coughing, or one that changes with posture. Most people with tension-type headache or migraine do not need one.
A nerve block, when occipital neuralgia is likely. If an injection of local anaesthetic around the nerve eases the pain for a while, that supports the diagnosis, and it can also be part of the treatment.
Blood tests, when they fit. For example, tests for inflammation when giant cell arteritis is possible.

A few weeks of a headache diary (where the pain started, what you were doing, what you took) often makes the pattern clear.

How to Get Rid of a Headache at the Back of the Head

The right treatment depends on the cause, which is why the diagnosis comes first. These help most people.

For the headache today. Rest, warmth across the neck and shoulders, gentle neck stretches and simple pain relief from the pharmacy can ease a tension-type headache.
Keep pain relief to two or three days a week at most. Taking it on too many days (15 or more days a month for simple pain relievers, 10 or more for some others) can itself keep headaches going: see medication overuse headache.
Look after the neck. Breaks from the desk, a screen at eye level, and exercises to strengthen and stretch the neck and shoulders, often with a physiotherapist, help both tension-type and cervicogenic headache.
Sleep, stress and exercise. Regular sleep, regular meals, regular exercise and ways to manage stress, such as relaxation training or psychological therapy, reduce how often headaches come.
Medicine, when headaches are frequent. Preventive medicines can reduce how often headaches occur. Your doctor can advise whether they suit you.
Treat the migraine, if migraine is present. Migraine treatment and prevention usually help the neck and the back of the head too.
For occipital neuralgia. A nerve block can ease the pain, and preventive medicines that calm nerve pain can help.

Where most people sit

Most people improve once the cause is clear and the treatment matches it, often with simple changes to posture, sleep and how pain relief is used. For those who need more, there are preventive treatments that help many people.

When to See a Neurologist About Headaches at the Back of the Head

Headaches at the back of the head keep coming back, or are becoming more frequent
You are not sure whether it is tension-type headache, migraine, your neck or a nerve
Headaches brought on by coughing, straining or a change in posture
Sharp, shooting pains at the back of the head
You are taking pain relief on many days a month
A new headache after 50 (see your GP the same day first)
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: working out which headache, or headaches, you have, arranging scans when the result will change what happens next, and coordinating with your GP and physiotherapist. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

Why does the back of my head hurt? +

Most often it is tension-type headache, migraine or a headache coming from the neck. The nerves of the upper neck and the nerves of the head meet in the same relay station, in the brainstem and the top of the spinal cord, so pain from the neck can be felt in the head, and migraine is often felt in the neck. Sharp, shooting pains at the back of the head can come from the occipital nerves (occipital neuralgia). A sudden, severe headache is different: call 000.

When should I worry about a headache at the back of my head? +

Call 000 if it comes on suddenly and reaches its worst within a minute, or comes with fever and a stiff neck, confusion, weakness, double vision, slurred speech or sudden unsteadiness. See your GP the same day if it is new after 50, keeps getting worse, is brought on by coughing or straining, or is worse sitting up and better lying down.

How do I get rid of a headache at the back of my head? +

It depends on the cause. For a tension-type headache, rest, warmth across the neck, gentle stretches and simple pain relief help. To prevent headaches, take breaks from the desk, keep the screen at eye level, sleep regularly, exercise and manage stress. Keep pain relief to two or three days a week at most, because using it more often can keep headaches going. If headaches are frequent, preventive medicines can help.

Why do I wake up with a headache at the base of my skull? +

Common reasons are short or poor sleep, an awkward neck position or pillow, grinding your teeth at night, and pain relief or caffeine wearing off overnight. Morning headaches are also more common with sleep apnoea, where breathing stops and starts during sleep, especially if you snore. A morning headache that keeps getting worse, or comes with vomiting, needs your GP the same day.

Can neck problems cause a headache at the back of the head? +

Yes. A cervicogenic headache starts in the neck or at the base of the skull and spreads forward, usually on one side, and is brought on by neck movements or by holding the head in one position. Tight, tender neck and shoulder muscles are also part of tension-type headache. Neck exercises, often with a physiotherapist, help both.

What is a spinal headache? +

A headache caused by fluid leaking from the tiny hole left by a lumbar puncture, a spinal anaesthetic or, occasionally, an epidural. It starts within five days, is worse sitting or standing and eases lying down, and often comes with a stiff neck. It is rarely dangerous, and most settle on their own within two weeks. If it is severe or lasting, contact the hospital that did the procedure: the leak can be sealed with a small injection of your own blood. A fever, or a headache that no longer eases when you lie down, needs urgent care.

Can high blood pressure cause a headache at the back of the head? +

Rarely. Long-standing high blood pressure does not usually cause headache, so a headache is not a reliable sign that your blood pressure is up. A sudden, very high rise, to a top number of 180 or more or a bottom number of 120 or more, can cause one. If your reading is still that high when you measure it again after 5 minutes of sitting quietly and you have a headache, go to an emergency department or call 000; call 000 straight away if there is also chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. A very high reading with no symptoms needs your GP the same day. Lower readings count in pregnancy, after a birth and after a spinal cord injury. From 20 weeks of pregnancy until 6 weeks after a birth, a severe headache, blurred vision or flashing lights, or a reading of 160/110 or more needs your maternity unit or an emergency department now (call 000 for a seizure, trouble breathing or chest pain), and a reading of 140/90 or more needs your midwife, maternity unit or GP the same day. With a spinal cord injury at mid-chest level or higher, a sudden, pounding headache needs you to sit upright, check your bladder, catheter and bowel, and call 000 if it does not settle within a few minutes or you cannot find the cause. Have your blood pressure checked regularly, headache or not. See headache with high blood pressure.

Could a headache at the back of my head be a brain tumour? +

Very unlikely. In a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have a brain tumour. Tumours usually cause other symptoms as well, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks, with vomiting. A headache with any of those needs prompt assessment.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache that peaks within a minute, a headache with a stiff neck and fever, or a headache with weakness, double vision, slurred speech or unsteadiness, call 000. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Headaches at the Back of Your Head?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

Book a Consultation

Call Us02 9388 0615

LocationSuite 301, Bondi Junction

Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.