When It Feels Like a Migraine — But Isn’t

If migraine medication isn’t working, your recurring headaches may not be migraines after all. Occipital neuralgia, a nerve-induced headache, can be confused with migraine because the symptoms can be similar:

  • Aching, burning or throbbing from the base of your head up to your scalp
  • Sharp, shock-like or piercing pain in your upper neck and back of head
  • Pain on one or both sides of your head
  • Pain behind your eyes
  • Tender scalp
  • Pain when moving your neck

But that’s where the similarities end. Occipital neuralgia and migraines require different treatments because their sources of pain are different. Migraines are related to changes in the brain. Occipital neuralgia is due to compressed or irritated nerves that run from the neck, up the back of the head to the scalp.

“Nerves can become entrapped due to muscle spasms or head or neck trauma, such as whiplash,” says Shrif Costandi, MD, a pain management specialist at Cleveland Clinic. “Sometimes we don’t know what causes it.”

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