Why Do I Get Headaches at the Back of My Head?
A headache at the back of your head is often linked to the upper neck. Tight muscles, stiff joints or poor alignment in the top three cervical vertebrae can send pain upward into the skull. This is called a cervicogenic headache. It is one of the most common reasons for ongoing occipital pain in adults.
Key points
- Most headaches at the base of the skull start in the upper cervical spine, not in the head itself.
- A forward head posture and screen habits are major contributing factors.
- Scans done lying down can miss alignment problems that only appear when you are upright and bearing your own weight.
- A standing whole-body scan shows how your neck, spine and pelvis work together under gravity.
- If you have a sudden severe headache, changes in your vision, or numbness, get urgent medical help first.
What does a headache at the back of your head feel like?
It usually feels like a deep, steady ache at the base of the skull. Sometimes it wraps around one side towards the temple or behind the eye. The pain can be dull and constant, or it can come in waves. Many people describe it as a heavy, pressing feeling rather than a sharp stab.
These symptoms overlap with the pattern of a tension headache at the back of the head. The difference often comes down to one thing: whether the pain is driven by muscle tension alone, or by a structural problem in the cervical spine.
What causes headaches at the base of the skull?
The most common cause is irritation of the joints, nerves or muscles in the upper cervical spine, around the C1, C2 and C3 vertebrae. The occipital nerves run from this area up and over the back of the skull. So any tension or misalignment here can send pain upward.
Less commonly, an occipital headache can be linked to a loss of the normal neck curve, known as cervical lordosis. When the neck straightens or reverses its natural curve, the load on the upper joints rises significantly.
How does neck alignment cause a headache at the back of your head?
Your neck does not work on its own. It sits on top of the thoracic spine, which sits on the pelvis. If your pelvis tilts or your mid-back curves too far forward, your neck has to compensate to keep your eyes level. This overworks the small muscles and joints at the very top of the spine, right where the occipital nerves sit.
This is compensation at work. Your pain is at the top, but the cause may be much further down. That is why a scan of the head alone, or even just the neck, often misses the bigger picture. If there is a cervical tilt or a pelvic imbalance underneath, treating only the headache symptoms will not solve the problem.
People who also have headache with lower back pain are a good example of this connected pattern.
How is a cervicogenic headache assessed with standing imaging?
A cervicogenic headache is assessed most accurately when you are upright and bearing your own weight. That is when gravity acts on your spine and shows how your body truly lines up. Lying down for a standard scan relaxes the muscles and lets the joints settle into an artificial position. This can hide the very misalignment that is causing your pain.
Weight-bearing EOS imaging captures your whole skeleton from head to feet in a single standing exposure. It shows your cervical curve, head position, thoracic kyphosis and pelvic alignment all at once. This lets the clinician trace the chain of compensation from bottom to top.
The EOS system uses about 90% less radiation than a standard X-ray, around ten times less. You stand still for a few seconds. No enclosed tube, no lying flat.
Lying-down imaging (conventional X-ray, CT or MRI) removes the effect of gravity. Your muscles relax, joints decompress, and subtle tilts or shifts disappear. For soft-tissue questions an MRI is often better. But for alignment questions, a lying-down image does not show the real picture.
ScanAlign standing EOS imaging at 19 Harley Street, London gives your clinician a full picture of how your skeleton behaves under its own weight. You do not need a referral from your doctor.
Ongoing headaches at the back of your head deserve a closer look at your neck alignment.
Book a free video consultationWhen is MRI better? EOS shows bones, joints and alignment very clearly. For soft tissue, discs, nerves or suspected nerve compression, MRI is usually the better tool. If your headache comes with numbness or tingling in the arm, your clinician may recommend MRI alongside or instead of a standing scan.
When should you see a doctor urgently for a headache at the back of your head?
Most occipital headaches are not dangerous, but some patterns need urgent attention. Contact your doctor, call your local emergency number, or go to the emergency department if you have any of the following:
- A sudden, severe "thunderclap" headache that peaks within seconds.
- Headache with numbness, weakness in your arms or legs, or difficulty speaking.
- Loss of bladder or bowel control along with head or neck pain.
- High fever, a stiff neck you cannot bend forward, or a rash that does not fade when pressed.
- Headache after a head injury, even a mild one.
- Changes in vision, double vision, or sudden loss of vision.
These are warning signs that need a medical assessment before any imaging is considered.
What helps manage headaches that start in the neck?
The first step is finding out exactly where the problem comes from. It may be joint stiffness, muscle tension, a change in the curve, or a compensation pattern further down the spine. Once you know which, a physiotherapist, osteopath or specialist can work with you more effectively.
General approaches that clinicians often recommend include better posture at the screen, targeted neck exercises, and dealing with jaw clenching habits. If your headaches are linked to wider posture patterns, it can help to look at how posture related headache triggers fit together.
ScanAlign does not provide treatment. It provides the detailed standing alignment assessment that helps your treatment provider target the actual cause, rather than just chasing the symptom.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
If you would like to book a standing spine scan, you can start with a free video consultation to discuss whether it is the right step for you before you plan a trip to London.
Frequently asked questions
Repeated headaches at the back of the head are most often caused by tension or stiffness in the upper cervical spine. The joints and muscles around C1, C2 and C3 can irritate the occipital nerves, sending referred pain up and over the skull. Forward head posture and long screen use are very common triggers.
A cervicogenic headache is a headache that starts in the neck rather than the brain. It is caused by referred pain from the joints, discs or muscles of the cervical spine. The pain usually starts at the base of the skull and can spread to the forehead, temple or behind the eye.
Yes. Forward head posture increases the load on the upper neck by a significant amount. This extra strain on the suboccipital muscles and neck joints is one of the most common contributors to tension headaches at the back of the head.
Most of the time, no. Cervicogenic and tension headaches are uncomfortable but not dangerous. However, a sudden, very severe headache, or one that comes with numbness, weakness, changes in vision or fever, needs urgent medical attention.
A standing EOS scan shows your whole skeleton under the force of gravity. It shows neck alignment, head position, spinal curves and pelvic tilt all in one image. Lying-down scans can miss subtle alignment shifts because gravity is removed and the muscles relax.
No. ScanAlign is a private, self-pay clinic. You can book directly yourself. You start with a free video consultation to discuss your symptoms and confirm the scan is suitable for you.
Yes. The EOS system uses about 90% less radiation than a standard X-ray, around ten times less. You stand still for a few seconds while the system captures a full-body image.
It depends on what your clinician is looking for. EOS is ideal for bone alignment, spinal curves and posture under gravity. MRI is better for soft tissue, discs and nerves. In some cases, both types of imaging are useful.
Yes. Cervicogenic headaches can mimic migraines, with one-sided pain, sensitivity to light, and nausea. The key difference is that cervicogenic headaches are triggered by neck movement or holding one posture for a long time, while migraines have neurological triggers. The two can also occur together.
The price for patients travelling from abroad is confirmed during the free video consultation. The consultation is the first step, and there is no obligation to book a scan afterwards.
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- Bogduk, N. & Govind, J. "Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment." The Lancet Neurology, 2009; 8(10): 959-968.
- International Headache Society. "The International Classification of Headache Disorders, 3rd edition." Cephalalgia, 2018; 38(1): 1-211.
- NHS. "Headaches." nhs.uk/conditions/headaches (accessed 2024).
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.