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Occipital neuralgia usually causes brief, severe, shooting or stabbing pain in the back of the scalp along an occipital nerve. Migraine usually lasts hours, may begin or spread to the back of the head, and commonly adds nausea or light and sound sensitivity. Location alone cannot separate them, and the two can coexist.
| Feature | Occipital neuralgia | Migraine | |---|---|---| | Pain quality | Shooting, stabbing, electric, sharp | Throbbing, pressing, or varied | | Episode length | Seconds to minutes, often repeated | Typically 4 to 72 hours untreated | | Distribution | Back of head and scalp along occipital nerve; may reach toward eye | One or both sides; front, temple, eye, neck, or back | | Between attacks | Tenderness or altered sensation may remain | Prodrome, aura, postdrome, or symptom-free interval | | Associated symptoms | Scalp tenderness or sensory change | Nausea, sensory sensitivity, movement intolerance; sometimes aura |
The International Headache Society criteria also use tenderness over the affected nerve and temporary improvement after local anesthetic block, but blocks must be interpreted by a qualified clinician and are not a home test.
Migraine commonly includes neck pain and scalp sensitivity. Occipital nerve pain can radiate toward the eye. A 2025 systematic review found that coexisting migraine was common among clinic-based patients diagnosed with occipital neuralgia, while also warning that the evidence was heterogeneous and lacked population-based studies.
That means “I have pain at the base of my skull” does not establish either diagnosis.
Use the headache location checker to organize location and associated symptoms. It cannot diagnose nerve pain or replace examination.
Get emergency help for sudden extreme headache, new weakness or speech trouble, seizure, severe confusion, fever with stiff neck, new vision loss, or headache after significant injury. Prompt review is also important for new scalp pain with rash, new headache after age 50, or pain with jaw fatigue or visual symptoms.
The conditions can coexist and pain pathways can interact, but a temporal association does not prove one caused the other.
Diagnosis is clinical. Imaging may be used when history or examination suggests another cause, but it does not automatically confirm occipital neuralgia.
No. Tenderness and response to touch are not specific, and forceful manipulation may worsen pain or be unsafe in some situations.
