Sub-Occipital Headaches
Pain at the base of your skull can be uncomfortable, particularly when it spreads upwards towards the back or side of your head. You might notice it after a day working at a computer, during a long drive, or when turning your head.
This area is known as the sub-occipital region, where several small muscles connect the upper neck to the base of the skull. Although discomfort here is sometimes described as a sub-occipital headache, pain in this location does not necessarily mean the headache originates from these muscles.
At Telford Osteopaths, we assess musculoskeletal factors that may contribute to neck-related headaches, including how the upper neck moves and whether associated muscle tension or joint stiffness may be involved.
What Is a Sub-Occipital Headache?
The sub-occipital muscles are a group of small muscles situated deep beneath the base of the skull. They help control fine movements of the head and upper neck.
People sometimes use the term sub-occipital headache to describe discomfort that begins around this region and may extend towards the back or side of the head.
However, sub-occipital headache is a descriptive term rather than a specific medical diagnosis.
One recognised type of headache that can involve this region is a cervicogenic headache, also called a headache arising from the neck.
Cervicogenic headaches are associated with structures in the cervical spine, including the joints and surrounding tissues of the upper neck.
Not every headache felt at the back of the skull is cervicogenic. Other types of headache and medical conditions can cause similar symptoms, which is why careful assessment matters.
Why Does Pain Develop at the Base of the Skull?
There are several possible reasons why discomfort may develop around the upper neck and base of the skull.
Muscle tension around the upper neck
The sub-occipital muscles contribute to head positioning and movement. Sustained positions or repetitive movements may contribute to muscular discomfort in this region.
Restricted neck movement
Stiffness or changes in movement around the cervical joints may be associated with some neck-related headaches.
Prolonged sitting and desk work
Working at a screen often involves remaining in relatively fixed positions. For some people, limited movement throughout the day may contribute to neck discomfort.
This does not mean that one particular sitting posture is inherently harmful or that poor posture is necessarily the cause of a headache.
Physical activity and daily demands
Activities involving sustained head positions, repeated neck movements or muscular effort may influence symptoms in some people.
Headaches are not always musculoskeletal in origin, however. The location of pain alone cannot establish its cause.
What Symptoms Might Occur?
People experiencing discomfort around the sub-occipital region may describe:
Aching or pressure near the base of the skull
Pain extending towards the back or side of the head
Associated neck stiffness
Discomfort when turning or extending the neck
Tenderness around the upper neck muscles
Symptoms that appear to vary with certain neck positions or movements
These features may occur with headaches arising from the neck, but they are not exclusive to cervicogenic headaches.
The pattern, severity, history and associated symptoms all need to be considered before conclusions are drawn.
Common Questions About Sub-Occipital Headaches
Why does the back of my head ache after working at a computer?
Spending long periods looking at a screen can involve relatively little variation in head and neck position.
For some people, this may be associated with muscular discomfort or stiffness around the upper cervical spine.
However, headaches occurring after screen use can have several explanations. Screen-related discomfort does not automatically indicate a problem with the sub-occipital muscles.
An assessment may help identify whether neck movement, muscle tension or other musculoskeletal factors are relevant.
Why do I notice pain at the base of my skull when turning my head?
Neck movement involves the cervical joints and surrounding muscles, including structures close to the base of the skull.
If particular movements are associated with headache symptoms, this may suggest that musculoskeletal factors deserve consideration.
However, pain during movement does not confirm a cervicogenic headache or identify a specific structure as the cause.
Why has an occasional ache at the base of my skull started happening more often?
A headache pattern can change over time.
For some people, variations in daily activity, sustained positions, sleep or neck discomfort may occur alongside changes in symptoms.
However, an increase in headache frequency should not automatically be attributed to muscular tension.
Headaches that are becoming more frequent, changing in character or progressively worsening warrant medical assessment to explore possible causes.
Why does the back of my head hurt during a long drive?
Driving can involve keeping the head relatively still while making repeated small movements to check mirrors and surroundings.
Some people notice upper neck discomfort during or after prolonged driving.
Whether this contributes to a headache depends on the individual, and symptoms should not be assumed to originate from the neck simply because they occur during driving.
Will Sub-Occipital Headaches Settle on Their Own?
Some episodes of muscular discomfort around the upper neck may fluctuate or settle without specific treatment.
However, the course of a headache depends on what is causing it. Pain around the base of the skull can arise from different conditions, and not all headaches follow the same pattern.
For headaches associated with musculoskeletal factors, understanding the relationship between symptoms, neck movement and daily activities may support decisions about management.
If headaches are recurring, persistent, worsening or changing in character, medical advice is appropriate.
How Do We Assess Neck-Related Headaches?
At Telford Osteopaths, the initial consultation lasts up to an hour and includes a detailed case history and physical examination.
For someone presenting with a possible neck-related headache, assessment may involve exploring:
The location and pattern of headache symptoms
How symptoms began and whether they have changed
Associated neck discomfort or stiffness
Cervical spine movement and function
Muscle tension and tenderness around the neck
Relevant work, activity and lifestyle influences
Previous medical history and other associated symptoms
The purpose is to understand whether musculoskeletal factors may be contributing to the symptoms and whether osteopathic care is appropriate.
Osteopathy may help with headaches arising from the neck, including cervicogenic headaches, depending on the individual assessment.
Where appropriate, osteopathic management may include hands-on techniques such as joint mobilisation, stretching and soft tissue treatment, alongside movement and exercise advice.
Any treatment options would be explained and discussed before proceeding. Responses vary, and not every headache is suitable for osteopathic management.
If the findings suggest a possible non-musculoskeletal cause, medical assessment may be recommended instead.
When Should You Seek Medical Advice?
Headaches should not automatically be assumed to originate from the neck muscles.
Seek emergency medical help for a sudden, extremely severe headache, particularly one that reaches maximum intensity within seconds or minutes.
Urgent medical assessment is also needed when a headache occurs with symptoms such as:
New weakness, numbness or difficulty speaking
Confusion, collapse or loss of consciousness
Fever with marked neck stiffness
New visual loss or significant visual disturbance
A recent significant head or neck injury
New or worsening headaches, particularly those that differ from your usual pattern, should also be discussed with a medical professional.
Osteopathic assessment should not delay appropriate medical investigation.
When Do People Consider Osteopathic Assessment?
Some adults consider osteopathic assessment when headaches appear to be associated with neck stiffness, movement or muscular discomfort.
For example, someone may notice aching around the base of the skull after prolonged desk work, while another person may experience discomfort alongside restricted neck movement during everyday activities.
In these situations, an assessment may help explore possible musculoskeletal contributors.
It is equally important to establish whether a headache may require medical investigation rather than musculoskeletal treatment.
Osteopathy is one of several approaches used to manage musculoskeletal pain, and the appropriate choice depends on individual circumstances.
Frequently Asked Questions
Can tight sub-occipital muscles cause headaches?
Muscular discomfort around the sub-occipital region may be associated with pain near the base of the skull. However, muscle tightness alone does not establish the cause of a headache. A broader assessment is needed to explore whether the symptoms are related to the neck.
Is a sub-occipital headache the same as a cervicogenic headache?
Not necessarily. Sub-occipital describes the anatomical area beneath the skull, while cervicogenic headache refers to a headache arising from structures in the neck. Pain in the sub-occipital region can have different causes and should not automatically be classified as cervicogenic.
Can osteopathy help with headaches at the base of the skull?
Osteopathy may help with headaches arising from the neck, including cervicogenic headaches. However, not every headache at the base of the skull originates from the cervical spine. Suitability for osteopathic care depends on the history, examination findings and individual circumstances.
Can a headache be related to neck stiffness?
Some headaches, particularly cervicogenic headaches, may be associated with reduced neck movement or discomfort around the cervical spine. However, neck stiffness can also occur alongside other headache conditions, so the relationship should not be assumed without assessment.
Do I need a GP referral before seeing an osteopath?
A GP referral is not usually required for an appointment at Telford Osteopaths, although some private medical insurers may require one.
If your symptoms suggest a medical condition requiring further investigation, GP or other appropriate medical assessment may be recommended.
What happens during my first appointment?
Your initial consultation lasts up to an hour. It includes a detailed case history and physical examination, followed by an explanation of the findings.
You can ask questions throughout, and any proposed treatment will be discussed before it begins.
Understanding Your Headaches
Discomfort at the base of the skull can be associated with the upper neck, but the position of the pain does not tell the whole story.
Understanding how symptoms developed, how they relate to movement and whether other medical factors need consideration is an important part of deciding what care may be appropriate.
If your headache appears to have a musculoskeletal component, an osteopathic assessment may help clarify the role of the neck and discuss suitable management options.
If you’d like to find out whether osteopathy could help, book online at www.telfordosteopaths.org or call 07480699221.
Clinical terminology note: The article deliberately distinguishes sub-occipital discomfort from cervicogenic headache. The accepted osteopathy treatment claim applies specifically to headache arising from the neck, rather than all headaches experienced at the base of the skull.
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