Greater occipital nerve

The greater occipital nerve is one of the nerves that carries feeling from the back of the head. Together with the lesser and third occipital nerves, it supplies the skin over the back of the scalp, and when one of them is irritated the result can be occipital neuralgia (Djavaherian & Guthmiller, 2023).

Where does the greater occipital nerve run?

It travels up through the layers of muscle at the back of the neck to reach the scalp. In a dissection study of 20 cadaver heads, it pierced the semispinalis muscle and came out to the surface at a point about 3 cm below the bony bump at the back of the skull and 1.5 cm to the side of the midline (Mosser et al., 2004).

A second study of 25 heads mapped six places along its route where the nerve could, in theory, be squeezed. The deepest lies between the semispinalis and the obliquus capitis inferior, one of the suboccipital muscles at the top of the neck. Others are where the nerve enters and leaves the semispinalis, where it passes through the trapezius and its attachment to the skull, and where the occipital artery crosses it (Janis et al., 2010). These maps were made to guide surgeons treating migraine; they show where compression is possible, not how often it happens.

What is occipital neuralgia?

The International Headache Society defines occipital neuralgia as shooting or stabbing pain in the back of the scalp, on one or both sides, along the path of the greater, lesser or third occipital nerves. To meet its criteria, the pain has at least two of three features: it comes in attacks lasting seconds to minutes, it is severe, and it is shooting, stabbing or sharp. It also comes with oversensitivity of the scalp or hair to light touch, plus tenderness over the nerve or at the point where the greater occipital nerve emerges. The pain eases for a while after a local anaesthetic block of the nerve (ICHD-3).

The pain can spread towards the forehead and around the eye, through nerve connections between the upper neck and the trigeminal nerve system, which serves the face (ICHD-3).

Is it the same as a headache from sitting at a desk?

Usually not. The same classification says occipital neuralgia must be told apart from pain referred to the back of the head from the upper neck joints or from tender spots in the neck muscles (ICHD-3). Those other headaches feel different:

• Tension-type headache is the most common type of headache. It is a mild to moderate, pressing or tightening pain on both sides, like a band, that isn’t made worse by walking, often with tender muscles (Shah et al., 2024).
• Cervicogenic headache is one-sided pain that starts in the neck and is referred to the head, often with reduced neck movement (Al Khalili et al., 2022).

The difference matters because the dull ache that builds over a long screen day belongs with neck pain from desk work and headaches linked to the neck, covered in Can neck pain cause headaches?. Brief, stabbing attacks with a scalp that hurts to touch are a reason to see a GP rather than to adjust your monitor.

What is a greater occipital nerve block?

It is an injection of local anaesthetic, sometimes with a steroid, near the nerve. Besides being part of the diagnosis of occipital neuralgia, it is used for migraine. A 2025 review found that most earlier reviews of it had significant flaws. Its own analysis found moderate-certainty evidence that a local anaesthetic block eases an acute migraine attack at 30 minutes, and low-certainty evidence that weekly injections on both sides reduce headache days in chronic migraine at one month. Whether the benefit lasts is unclear, and no serious adverse effects were reported (Atraszkiewicz et al., 2025).

When to see a doctor

See a GP if you regularly get headaches or a headache isn’t getting better. Ask for an urgent GP appointment or contact NHS 111 if you have a headache with jaw pain when eating or a sore, tender scalp, a headache with vision problems, or one that is made worse by coughing, sneezing or bending down. Call 999 if a headache starts suddenly and is extremely painful, or comes with weakness or numbness, confusion, difficulty speaking, a very high temperature with a stiff neck, or a rash that doesn’t fade under a glass (NHS).