Who This Blog Is For: You know the exact spot. Base of the skull, usually one side, and every so often something fires from there straight up the back of your head like a wire touching metal. If you have been told it’s migraine and the migraine plan isn’t touching it, this blog is for you. It’s also for anyone in Woodway, Waco, Hewitt, China Spring, and Robinson who has learned to brush their hair carefully because the scalp on that side has started to feel wrong.
You can put a finger on it, which is the strange part. Most headaches are a fog with no address. This one has a return address at the base of your skull, and from there it shoots, stabs, and sometimes ends behind the eye on the same side. Then it stops. Then, hours or days later, it does it again.
Key Insights
- Occipital neuralgia is nerve pain in the occipital nerves, the nerves that run from the top of your neck up across the back of your scalp.
- It has a distinct signature: brief, shooting, stabbing attacks lasting seconds to minutes, often with a tender spot at the base of the skull and a scalp that feels sensitive to light touch.
- Roughly 90% of cases involve the greater occipital nerve, which comes off the second neck bone, C2, and threads up through muscle before reaching the scalp.
- The official diagnostic criteria specifically warn that pain in this pattern can also be referred from the atlantoaxial joint, the joint between your top two neck bones, rather than from the nerve itself.
- That distinction is exactly why an Upper Cervical assessment belongs in the conversation, and why guessing at it isn’t good enough.
What Occipital Neuralgia Actually Is
Three nerves supply the back of your scalp, and all three start in your neck.
The greater occipital nerve comes off the back branch of the C2 nerve root, the second bone down in your neck. It runs upward through the deep muscles at the base of your skull, pierces through the semispinalis and trapezius muscles, and fans out across the back and top of your scalp. It accounts for about nine out of ten cases of occipital neuralgia. The lesser occipital nerve, off the front branch of C2, climbs along the side of the neck and covers a smaller patch behind the ear. The third occipital nerve, from C3, is rarely the culprit.
When one of these nerves is irritated or compressed anywhere along that path, the pain it produces has a recognizable character. The international headache classification describes it as paroxysmal shooting or stabbing pain in the back of the scalp, along with tenderness over the nerve and a scalp that can feel unpleasant or painful to ordinary touch. Attacks run seconds to minutes rather than hours. Between them, a dull ache in the same territory is common.
It is not a common diagnosis. Population data puts new cases at roughly 3.2 per 100,000 people per year, with an average age at diagnosis in the mid-fifties. That rarity is part of why it gets missed, and part of why people carry it for years under a different name like migraines or cervicogenic headaches.
Why It Gets Called Migraine
Both conditions produce one-sided head pain. Both can bring light sensitivity. Both can end behind the eye. If you have been handed a migraine diagnosis and a migraine plan, that was a reasonable first read.
The tell is in the shape of the attack. Migraine builds and lingers, often for hours, and tends to throb. Occipital neuralgia snaps, seconds to a couple of minutes of electric, stabbing pain, then it’s gone. Migraine doesn’t usually make your scalp hurt to comb. Occipital neuralgia often does, and there’s frequently a spot at the base of the skull that reproduces the pain when you press it.
There’s a second reason the two blur together. The nerves from your upper neck and the nerve that carries sensation from your face and head share the same relay station in the brainstem. Signals from the neck arrive at the same neurons that handle head and face signals, so pain that starts in the upper neck can be genuinely felt across the front and side of the head. Your brain isn’t being imprecise. The wiring is shared.
The Joint the Nerve Passes Right Beside
The diagnostic criteria for occipital neuralgia include a line that rarely makes it into a patient conversation.
The classification says the condition must be distinguished from pain referred from the atlantoaxial joint or the upper facet joints of the neck, and from trigger points in the neck muscles. In plain language: the same pain pattern can come from the joints at the very top of your neck instead of from the nerve.
The atlantoaxial joint is where your Atlas, the top bone in the neck, meets the bone directly beneath it. It sits inches from where the greater occipital nerve emerges. The nerve then travels through the obliquus capitis inferior, one of the small deep muscles that connects those same two bones, and known compression points sit right there and at the C2–C3 level.
So the nerve, the muscle, and the joint all occupy the same small piece of anatomy at the base of your skull. When the alignment of that area is off, the tissue around that nerve doesn’t sit the way it was built to sit. This is where every problem has a cause stops being a slogan, and becomes a specific question with a specific place to look.
What an Upper Cervical Assessment in Waco Looks At
Atlas Chiropractic is an Upper Cervical practice, which means the work centers on the top two bones in your neck and how your head sits on them. That’s a narrower focus than general chiropractic on purpose, because this region is small, individual, and unforgiving of approximation.
It starts with the Blueprint Spinal Analysis, a full assessment of spinal health built around precise imaging of your upper neck. Posture measurement and thermal scanning support the picture. The imaging is the centerpiece, because the angles at the top of your neck are yours alone, and no two people’s numbers are the same. We never guess about your health, and precise imaging is how guessing gets taken off the table.
What the assessment answers is a narrow question, honestly framed: is there a structural contributor at the top of your neck that belongs in your case? Sometimes there is. Sometimes there isn’t, and if we find we’re not the best people to help you, we’ll tell you and point you toward someone who is.
If there is something to work with, the correction is specific, gentle, and calculated from your own measurements rather than delivered as a standard adjustment. There’s no twisting or cracking of the neck.
What Care Looks Like, and How Long It Takes
Full correction of an Upper Cervical misalignment is measured in months, not visits. The realistic window is 18 to 24 months, and the reason is biological: the ligaments that hold your alignment are made largely of collagen, and remodeled collagen takes that long to mature into tissue that holds a new position on its own. What this means for you is that your spine has moved from injured and compromised into something that will be stable long-term.
That does not mean 18 months before you feel better. Changes in symptoms often show up much earlier. In a prospective study following 1,090 new Upper Cervical patients across 83 practices, headache, neck pain, and disability scores improved significantly within about two to three weeks of starting care, with high patient satisfaction. That study also found short-lived mild soreness after adjustments was fairly common, intense reactions were uncommon, and across more than five million career Upper Cervical adjustments, the participating practices reported no serious adverse events. It was a cohort study rather than a randomized trial, and the authors say plainly that randomized work is still needed. It’s encouraging evidence, and one that other offices also report.
Finding Out Whether Your Neck Is Part of This
If the pain has an address at the base of your skull, and the plans you’ve tried were built for a different kind of headache, the top of your neck is worth ruling in or out.
The consultation is complimentary. You sit down with Dr. Flick, you describe what’s actually happening in your own words, and you find out whether this is something Atlas can help with. If you choose to move forward the same day, the Comprehensive Exam is a flat $150 investment. Your Report of Findings, where the results are laid out and recommendations are made, happens at a separate visit and is always complimentary. No insurance is billed here, and a Superbill is provided so you can seek reimbursement on your own if you’d like.
This is the kind of expertise you’d otherwise drive hours to find, in a small-town practice where people know your name. Whatever you decide, you deserve a real answer about that spot at the base of your skull.
Frequently Asked Questions
How do I know if it’s occipital neuralgia or a migraine?
The clearest clues are the length and quality of an attack. Occipital neuralgia tends to fire in short bursts, seconds to a couple of minutes, with a shooting or stabbing quality, often with scalp tenderness and a sore spot at the base of the skull. Migraine typically builds and lasts hours with a throbbing quality. Neither pattern is diagnostic on its own, and the two can coexist. A physician makes the diagnosis; an Upper Cervical assessment looks at whether your neck structure is contributing.
Can occipital neuralgia be caused by a neck injury?
Yes, it can follow head or neck trauma, though it also appears without any injury anyone can recall. Whiplash, a fall, a sports collision, or an old accident you’d stopped thinking about are all worth mentioning at your consultation, even if they happened decades ago and even if you felt fine afterward.
Does Upper Cervical care replace my neurologist?
No. It works alongside your physicians. Your doctor diagnoses and manages the condition, including options like nerve blocks and medication. Upper Cervical care examines a structural contributor at the top of the neck that a standard headache workup isn’t designed to measure.
Why does my scalp hurt when nothing is touching my head?
When a sensory nerve is irritated, the tissue it supplies can become oversensitive, so ordinary sensations like hair brushing against a pillow register as painful. The classification for occipital neuralgia specifically includes this kind of scalp sensitivity and discomfort as a feature of the condition.
What happens at a first visit at Atlas?
Your consultation is complimentary and conversational. If you choose to proceed the same day, the Comprehensive Exam is a flat $150 investment and includes the Blueprint Spinal Analysis with precise imaging of your upper neck. Your Report of Findings comes at a separate visit and is complimentary, so you have time to think and we have time to study your images properly.
To schedule a consultation with Dr. Flick, call our Waco office at 254-304-7474. You can also click the button below.
If you are outside of the local area, you can find an Upper Cervical Doctor near you at www.uppercervicalawareness.com.
Reviewed by Dr. Christy Flick, DC · Last reviewed August 2026
This article is for educational purposes and shares general information about upper cervical chiropractic care. It isn’t a substitute for an individual clinical assessment, and results vary from person to person. If you’re wondering whether this could be the source of what you’re dealing with, we’d welcome the chance to take a look — schedule a complimentary consultation at atlaschiropracticwaco.com or call 254-304-7474.
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