The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. New, severe, or changing headache after head injury warrants prompt assessment by a physician, neurologist, or headache specialist to confirm the diagnosis and exclude dangerous causes. Consult a concussion-experienced clinician for individualized care. Back-of-head-only pain differs from typical post-concussion headache because pain concentrated at the base of the skull and back of the head points strongly to a cervical or occipital source rather than a diffuse migraine or tension pattern (Ashina et al., 2019). The back of the head is the territory of the upper cervical joints and the occipital nerves, which arise from the upper neck. When pain localizes here after concussion, it most often reflects cervicogenic headache, referred from dysfunctional upper cervical joints, or occipital neuralgia, from irritation of the occipital nerves. Both are highly treatable with physical therapy and nerve-directed care. Recognizing the occipital location directs treatment straight to the neck rather than to general headache medication. The back of the head is the territory of the upper neck joints and occipital nerves. Pain localized here points to cervicogenic headache or occipital neuralgia. Both are highly treatable with physical therapy and nerve-directed care. What Typical Post-Concussion Headache Looks Like The common post-concussion headaches, tension-type and migraine, are usually more diffuse. Tension-type headache encircles the head in a band, and migraine is often frontal or one-sided with throbbing and associated features. Pain that concentrates specifically at the back of the head and the base of the skull, rather than spreading across the whole head, stands apart from these patterns and points to the structures of the upper neck. Why the Occipital Location Points to the Neck The back of the head and the base of the skull are anatomically tied to the upper cervical spine. The upper cervical joints, particularly the first three, refer pain to the occiput and back of the head through the trigeminocervical nucleus, the brainstem region where upper cervical and head pain signals converge. The greater and lesser occipital nerves, which supply sensation to the back of the scalp, arise from these same upper cervical levels and travel through the neck muscles to the scalp. Because both the joints and the nerves of this region project to the back of the head, pain localized there is far more likely to originate in the neck than pain elsewhere on the head. Concussion commonly injures the upper neck in the same event, producing joint dysfunction, muscle guarding, and nerve irritation. This is why back-of-head pain is such a strong pointer to a cervical or occipital source after concussion. Cervicogenic Headache Versus Occipital Neuralgia Two related sources dominate back-of-head pain. Cervicogenic headache is referred pain from dysfunctional upper cervical joints and muscles. It tends to be a steady ache that starts in the neck or occiput and spreads forward, is reproduced by neck movement or by pressure on the involved joints, and is often accompanied by reduced neck mobility. Occipital neuralgia is nerve pain from irritation or entrapment of the occipital nerves. It is sharper, shooting, stabbing, or electric, radiates from the skull base over the back of the head, and brings scalp tenderness and reproduction of pain by pressure over the nerve. The two frequently coexist, and both trace back to the upper neck. Symptom Presentation Pain concentrated at the base of the skull and back of the head A steady ache spreading forward from the neck or occiput, suggesting cervicogenic headache Sharp, shooting, or electric pain over the back of the head, suggesting occipital neuralgia Reproduction with neck movement or pressure on the upper cervical joints or nerve Scalp tenderness and sensitivity with occipital neuralgia Reduced neck mobility and coexisting neck pain Worsening with sustained postures and neck positions Assessment A clinician examines the upper cervical spine for the joint restrictions, muscle tension, and trigger points that reproduce the back-of-head pain, and tests whether pressure over the occipital nerve reproduces a shooting neuralgic pain. Reproduction of the familiar headache from the neck or nerve confirms a treatable source. A diagnostic occipital nerve block that relieves the pain confirms occipital neuralgia. The assessment distinguishes cervicogenic headache from occipital neuralgia, which often coexist, and excludes other causes when the pattern is atypical. Treatment Approach Treatment is directed at the neck and nerve. For cervicogenic headache, manual therapy to the restricted upper cervical joints, release of the tense suboccipital and neck muscles, deep cervical flexor retraining, and posture correction reduce the referred pain at its source. For occipital neuralgia, releasing the entrapping muscles, restoring upper cervical mobility, and occipital nerve blocks calm the irritated nerve, with gentle rather than aggressive early stretching to avoid increasing nerve irritability. Because both sources arise from the upper neck, cervical physical therapy is the central treatment, and back-of-head headaches that resist medication frequently improve when the neck is addressed. Posture correction and deep cervical strengthening protect against recurrence. The general supports, diaphragmatic breathing for autonomic regulation, sleep, and avoiding medication overuse, reduce the overall burden, but the specific treatment targets the cervical and occipital source that the location identifies. Post-traumatic headache often has a cervical and autonomic component that responds to daily mobility and nervous system regulation alongside medical care. Start your 3-day free trial to build a supportive routine. Supporting Mobility Routine JME 155 Diaphragmatic breathing lowers the sympathetic drive that fuels headache and supports steady cerebral blood flow. Ten slow breaths, several times daily. JME 14 Chin tucks activate deep cervical flexors and reduce the upper cervical tension that refers pain to the head. Ten repetitions with 5-second holds. JME 1 Cervical rotation restores segmental mobility at the joints that refer pain into headache through the trigeminocervical nucleus. Ten repetitions per direction. JME 15 Cervical lateral flexion addresses side-bending restriction that sustains neck-driven headache. Ten repetitions per side. JME 16 Cervical flexion and extension restore sagittal mobility restricted by suboccipital guarding. Eight slow repetitions. JME 2 Cervical retraction reinforces a neutral head position that reduces the postural strain feeding headache. Ten repetitions per set. JME 150 Thoracic rotation restores mid-back motion needed for full cervical range and relaxed upright posture. Eight repetitions per direction. JME 227 Overhead reach opens the thoracic spine and reduces the compensatory upper cervical extension that drives headache. Ten repetitions with controlled tempo. Start your 3-day free trial for joint-specific mobility programming that addresses the cervical and autonomic contributors to post-traumatic headache. Common Mistakes Treating back-of-head pain with general headache medication while ignoring the neck Missing the reproducible upper cervical joint or occipital nerve source on examination Not distinguishing cervicogenic headache from occipital neuralgia, which guide different care Aggressive early suboccipital stretching that increases nerve irritability Leaving posture and deep cervical weakness unaddressed, allowing recurrence Progression Assessment reproduces the back-of-head pain from the upper cervical joints or occipital nerve and distinguishes cervicogenic headache from occipital neuralgia, with a diagnostic nerve block when neuralgia is suspected. Treatment targets the neck and nerve with manual therapy, muscle release, deep cervical retraining, posture correction, and nerve blocks. General supports reduce the overall burden. Back-of-head pain often improves markedly as the neck is treated. What does back-of-head-only pain after a concussion usually mean? Pain concentrated at the base of the skull and back of the head points strongly to a cervical or occipital source, the upper neck joints and the occipital nerves, rather than a diffuse migraine or tension pattern. It most often reflects cervicogenic headache or occipital neuralgia, both highly treatable with physical therapy and nerve-directed care. Why does pain at the back of my head point to my neck? The upper cervical joints refer pain to the occiput through the trigeminocervical nucleus, and the occipital nerves that supply the back of the scalp arise from the same upper cervical levels. Because both the joints and nerves of this region project to the back of the head, pain there is far more likely to originate in the neck. How do I tell cervicogenic headache from occipital neuralgia? Cervicogenic headache is a steady ache that spreads forward from the neck and is reproduced by neck movement or joint pressure. Occipital neuralgia is sharper, shooting, or electric, radiates over the back of the head, and brings scalp tenderness with reproduction by pressure over the nerve. They often coexist, and both trace to the upper neck. How is back-of-head pain treated after a concussion? Treatment targets the neck and nerve: manual therapy to the upper cervical joints, release of the suboccipital and neck muscles, deep cervical retraining, and posture correction for cervicogenic headache, plus occipital nerve blocks and gentle nerve care for occipital neuralgia. Back-of-head pain that resists medication frequently improves when the neck is addressed. Why doesn't headache medication help my back-of-head pain? Because the pain is generated by upper cervical joint dysfunction and occipital nerve irritation rather than by the mechanisms general headache medication targets. Treating the source in the neck with physical therapy and nerve-directed care reduces the pain, which is why back-of-head pain that resists medication often responds to cervical treatment. Red Flags Requiring Urgent Evaluation The following warrant same-day emergency evaluation rather than routine care. Sudden severe headache that peaks within seconds to minutes Headache with fever, neck stiffness, or rash New weakness, numbness, slurred speech, or facial droop New vision loss, double vision, or a persistent visual change Progressive worsening headache over days to weeks Headache with confusion, drowsiness, or repeated vomiting Headache that is worse lying down, wakes the person, or worsens with straining Sudden severe neck pain with neurological symptoms, suggesting arterial dissection These features can indicate a dangerous cause and take priority over any headache-specific diagnosis. Absence of red flags supports outpatient evaluation and management. Tracking Triggers and Patterns With a Headache Diary A headache diary is one of the most useful tools for post-traumatic headache. Recording the timing, location, quality, and severity of each headache, along with sleep, meals, hydration, menstrual cycle, weather, activity, and medication use, reveals the patterns and triggers that guide treatment. Over a few weeks, a diary shows whether headaches cluster around specific triggers, whether medication use is creeping toward overuse, and which phenotype dominates. Bringing this record to a clinician sharpens the diagnosis and the plan far more than memory alone. Medication Overuse Headache Frequent use of acute headache medication can produce medication overuse headache, where the treatment itself sustains a daily or near-daily headache. This is common after concussion, when frequent pain drives frequent medication use. As a general guide, using simple analgesics on 15 or more days per month, or triptans, combination analgesics, or opioids on 10 or more days per month, raises the risk. Preventive treatment and careful limits on acute medication, guided by a clinician, break the cycle. Why Location and Triggers Matter for Diagnosis Post-traumatic headache is not one condition. Its location, timing, quality, and triggers point toward specific phenotypes, migraine, tension-type, cervicogenic, or a trigeminal autonomic cephalalgia, and each has different treatment. Where the pain sits, what sets it off, and how it behaves are diagnostic clues, not incidental details. A precise diagnosis by a physician, neurologist, or headache specialist, using the criteria of the International Classification of Headache Disorders, directs the person to the treatment most likely to work and avoids prolonged trial and error. A cervical contribution is common across phenotypes and responds to physical therapy alongside medical care. References Ashina, H., et al. (2019). Post-traumatic headache: epidemiology and pathophysiological insights. Nature Reviews Neurology, 15(10), 607-617. PubMed Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1-211. PubMed Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed