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Back and neck MediBilbao Salud

Pain at the Base of the Skull: Causes, Relief and When to Worry

Pain where the back of the head meets the neck is very common. Most of the time it comes from tight muscles, sustained postures or irritated joints and nerves in the upper neck, and it often brings a headache that wraps around the head or travels towards the eyes. It usually responds well to movement, better habits and physiotherapy. A few patterns, especially a sudden, severe headache, need urgent medical attention.

Topic
Physical therapy
Updated
Reading time
5 minutes
Reviewed by
Dr. Itziar Gotxi Erezuma · Medical doctor (ENT) · Bizkaia Medical Association no. 484809757

What is at the base of the skull

Several structures meet at the back of the head: the suboccipital muscles, which fine-tune head movements and posture; the upper trapezius and other neck muscles; the joints between the skull and the first two neck vertebrae; and the greater and lesser occipital nerves, which run up through the muscles to the scalp. Pain signals from these structures share pathways with nerves from the head, which is why neck problems can be felt as a headache at the back of the head, the temples or behind the eyes.

Common causes

  • Tension-type headache: a pressing, band-like pain on both sides, often with tender neck and shoulder muscles; linked to stress, poor sleep and posture.
  • Muscle strain and sustained postures: looking down at phones or forward at screens for long periods overloads the muscles at the base of the skull; see forward head posture.
  • Cervicogenic headache: a headache originating in the upper neck joints, usually on one side, triggered or worsened by neck movements or sustained positions, with reduced neck movement.
  • Occipital neuralgia: sharp, shooting or electric pain from the base of the skull over the back of the scalp, with tenderness over the nerve.
  • Whiplash and other neck injuries: pain and stiffness after a car accident or fall.
  • Sleep position and pillows: waking with pain at the base of the skull; see neck pain from sleeping.
  • Arthritis of the neck (cervical spondylosis): more common after 50.
  • Migraine: can start at the back of the head before spreading.

Clues from the type of pain

  • Dull, tight, both sides, worse at the end of the day: tension-type headache or muscle strain.
  • One side, starts in the neck and spreads forward, worse with turning the head: cervicogenic headache.
  • Brief shooting or electric jolts over the scalp: occipital neuralgia.
  • Throbbing, with nausea and sensitivity to light: migraine.
  • Pain with a blocked nose and facial pressure: sinus problems are possible but less common than assumed; see sinus headache at the back of the head.

What you can do now

  • Apply heat to the back of the neck for 15 to 20 minutes.
  • Take movement breaks every 30 to 45 minutes when working at a screen.
  • Raise the screen to eye level and bring the keyboard close so you do not lean forward.
  • Use a pillow that keeps the neck level with the rest of the spine.
  • Stay hydrated, keep regular meals and protect your sleep.
  • Use painkillers sensibly: taking them on more than 10 to 15 days a month can cause medication-overuse headache.

Gentle exercises

  • Chin tucks: glide the chin straight back, hold for 5 seconds, 10 repetitions, several times a day.
  • Upper trapezius stretch: tilt the ear towards the shoulder, hold for 20 to 30 seconds each side.
  • Levator scapulae stretch: turn the head 45 degrees and look down towards the armpit, hold for 20 to 30 seconds.
  • Shoulder blade squeezes: draw the shoulder blades back and down, hold for 5 seconds, 10 repetitions.
  • Neck rotation: turn slowly to each side within comfort, 10 times.

Movements should feel like a mild stretch, not pain. More routines in back and neck stretches and neck muscle strain.

How physiotherapy and doctors help

A physiotherapist assesses neck movement, muscle function and posture, and tests whether moving the upper neck reproduces the headache. Treatment for neck-related headache combines manual therapy, such as joint mobilisation and soft tissue work, with exercises for the deep neck flexors and shoulder blade muscles; this combination has good evidence. Relaxation techniques and graded activity help with tension-type headache.

A doctor may consider other medicines for frequent tension-type headaches or migraine, and nerve blocks for occipital neuralgia. Scans are only needed when there are warning signs or the pattern is unusual.

When pain at the base of the skull is urgent

  • A sudden, severe headache that peaks within a minute («thunderclap»).
  • Headache with fever, a stiff neck, a rash or sensitivity to light.
  • Headache after a head injury, especially with vomiting or drowsiness.
  • Weakness, numbness, confusion, slurred speech or loss of vision.
  • A new headache after 50, or in someone with cancer or a weakened immune system.
  • Headache that wakes you from sleep and keeps getting worse over weeks.

These can be signs of bleeding in the brain, meningitis or other serious conditions. Call emergency services or go to the emergency department.

Key points to remember

  • Pain at the base of the skull is usually muscular or comes from the upper neck.
  • Breaks from screens, heat, a good pillow and gentle exercise often help.
  • Physiotherapy is effective for neck-related headaches.
  • Sudden severe headache or headache with fever and stiff neck is an emergency.

Questions about pain at the base of the skull

These answers are general information and do not replace an examination or individual medical advice.

Why does the base of my skull hurt?

Most often because of tight neck muscles, sustained postures, tension-type headache or irritation of the upper neck joints or occipital nerves.

Can stress cause pain at the base of the skull?

Yes. Stress increases muscle tension and is a common trigger for tension-type headaches felt at the back of the head.

Is pain at the base of the skull a sign of high blood pressure?

Rarely. Only very high blood pressure tends to cause headaches. If you are concerned, have your blood pressure checked.

What is the fastest way to relieve it?

Heat, gentle neck movements, a break from the screen and, if suitable, a simple painkiller.

Can a pillow cause pain at the base of the skull?

Yes. A pillow that is too high, too flat or too firm can strain the neck overnight.

When should I worry about pain at the back of my head?

If it is sudden and severe, comes with fever and a stiff neck, follows a head injury, or comes with neurological symptoms.

Sources

  1. NHS · Tension headaches
  2. NHS · Headaches
  3. NHS · Neck pain
  4. Blanpied PR, et al. Neck pain: revision 2017. Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health. J Orthop Sports Phys Ther. 2017
  5. Mahmoud NF, et al. The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Curr Rev Musculoskelet Med. 2019

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.