Back of the head pain refers to pain or discomfort occurring at the back of the head. Causes vary, including both physiological and pathological factors. Symptoms typically present as headaches, tightness, or dull pain, possibly accompanied by nausea and vomiting. Long-term or severe back of the head pain can severely impact daily life and work, and may even signal a serious illness. The prognosis depends on the specific cause of the pain and the treatment options. Generally, with timely and effective treatment, the pain can be relieved or eliminated.
symptom
Typical manifestations
The typical manifestations of back of the head pain are mainly bloating, dull pain or throbbing pain in the back of the skull. This pain can be continuous or transient.
Associated symptoms
1. Nausea and vomiting
It is usually related to increased intracranial pressure or meningeal irritation, and is more common in cases of intracranial tumors or intracranial infections.
2. Dizziness
It is more common in posterior cranial fossa lesions, such as intracranial tumors.
3. Fever
Meningitis patients may experience fever in addition to pain in the back of the head.
4. Psychiatric symptoms
Tension-type back pain and back pain caused by mental illness are often accompanied by mental symptoms such as insomnia and anxiety.
5. Autonomic nervous system symptoms
Pain in the back of the head is often accompanied by symptoms such as pale complexion, sweating, palpitations, vomiting and orthostatic hypotension.
complication
This symptom generally has no obvious complications.
reason
Overview
There are many causes of back of brain pain, including physiological factors such as drug factors, environmental factors, lifestyle, and mental factors, as well as pathological factors such as intracranial diseases, extracranial diseases, and neurosis.
Cause of symptoms
1. Physiological factors
(1) Drug factors: Certain drugs, such as vasodilators, some antibiotics, and analgesics, may cause back of the head pain as a side effect.
(2) Environmental factors: High noise, excessive or dim light, high temperature environment, etc. may cause back of the head pain.
(3) Lifestyle: Long-term lack of sleep, work fatigue, and excessive use of the brain are prone to back pain. Bad habits such as smoking and alcoholism can also cause back pain.
(4) Mental factors: Emotional states such as anxiety, depression, and tension may cause pain in the back of the head.
2. Pathological factors
(1) Intracranial diseases: including intracranial infectious diseases such as meningitis and encephalitis, intracranial vascular diseases such as cerebral hemorrhage, subarachnoid hemorrhage, cerebral vasospasm, and intracranial space-occupying lesions such as brain tumors and brain abscesses.
(2) Extracranial diseases: Cervical spondylosis, especially cervical disc herniation or cervical bone hyperplasia, may compress the nerve roots and cause pain in the back of the head. Occipital neuralgia can also cause pain in the back of the head and may be related to factors such as cervical spondylosis, infection, and inflammation. Temporal arteritis is an inflammatory disease that affects the temporal artery and may also cause pain in the back of the head. In addition, diseases such as glaucoma, otitis media, sinusitis, and pulpitis may cause pain in the back of the head through nerve conduction.
(3) Neurosis: Neurasthenia, hysteria, etc. may cause pain in the back of the head.
(4) Other diseases: systemic acute and chronic infections, cardiovascular diseases, poisoning, heat stroke, uremia, etc. may also cause back of the head pain.
Common diseases
Meningitis, encephalitis, cerebral hemorrhage, subarachnoid hemorrhage, cerebral vasospasm, brain tumor, brain abscess, cervical spondylosis, occipital neuralgia, temporal arteritis, glaucoma, otitis media, sinusitis, pulpitis, neurasthenia, hysteria, poisoning, heat stroke, uremia
Seeking medical treatment
Emergency (120) indications
1. The pain in the back of the head occurs suddenly and is severe.
2. Accompanied by nausea and vomiting, especially projectile vomiting.
3. Accompanied by dizziness and loss of balance.
4. Accompanied by blurred vision and visual field loss.
5. Accompanied by language disorders and dysphagia.
6. Accompanied by limb numbness, weakness, and hemiplegic limb dysfunction.
7. Accompanied by impaired consciousness, such as drowsiness, lethargy, coma, etc.
8. Other critical situations occur.
In all of the above cases, you must call the emergency number or go to the emergency department immediately.
Outpatient indications
1. Continuous or paroxysmal pain in the back of the head.
2. Accompanied by neck stiffness, nausea and vomiting, blurred vision, and photophobia.
3. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
If the patient’s condition is serious, he or she should go to the emergency department in time; if the condition is mild, he or she can go to the neurology department or neurosurgery department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A comprehensive neurological examination may be performed, and it is recommended that you wear clothing and shoes that are easy to put on and take off.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Prepare a list of questions you want to ask in advance.
7. Blood tests may be performed, and it is best to visit the doctor in the morning on an empty stomach.
What questions might a doctor ask a patient?
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Are your symptoms persistent or intermittent? Is there a pattern?
4. Have your symptoms gotten worse or better since you became ill? What’s the reason?
5. Have you ever had similar symptoms before?
6. Have you ever received treatment before? How was it treated? What was the effect?
7. Are you taking any medications?
8. Do you smoke? How long have you been smoking? On average, how many cigarettes do you smoke per day?
9. Do you drink alcohol? How long have you been drinking? How much do you drink on average per day?
What questions can patients ask their doctor?
1. Is my condition serious? Can it be cured?
2. Why does this happen to me?
3. What treatment do I need? Do I need to be hospitalized? How long will it take to recover?
4. What are the risks of these treatments?
5. If medication is used for treatment, what are the usage, dosage and precautions of the medication?
6. What tests do I need? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Scheduled inspection
Doctors usually perform a physical examination on the patient first to gain a preliminary understanding of the disease; they may then recommend a routine blood test, biochemical test, cerebrospinal fluid test, head CT scan, head MRI, cervical spine MRI, intracranial vascular ultrasound, electroencephalogram, lumbar puncture and other tests to determine the specific cause of the back of the head pain.
Physical examination
1. The doctor will observe whether the patient has any trauma or swelling on the head, and will also examine the back of the patient’s head through palpation to preliminarily determine whether there is local tenderness.
2. The doctor will also observe the patient’s state of consciousness and whether there are other abnormal neurological manifestations, such as speech disorders, limb weakness, etc.
3. The doctor will also measure the patient’s blood pressure to determine whether the patient has hypertension.
Laboratory tests
1. Blood routine test
Blood tests are done to determine the number of red blood cells, white blood cells and neutrophils in the blood to determine whether there is infection, anemia, etc.
2. Routine biochemistry
Including indicators such as liver function, kidney function, blood sugar, and blood lipids, which help to understand the patient’s overall health status.
3. Cerebrospinal fluid examination
In certain cases, your doctor may recommend a cerebrospinal fluid test to rule out conditions such as intracranial infection.
Imaging examinations
1. CT scan of the head
It can quickly image and display the structures within the brain, which helps diagnose diseases such as hemorrhagic stroke and subdural hematoma.
2. MRI (magnetic resonance imaging) of the head
It can provide more detailed brain tissue information, which helps in diagnosing cerebral infarction, brain tumors and other diseases.
3. Cervical spine MRI
It can assess the degree and cause of cervical nerve compression, which helps diagnose back of the head pain caused by cervical spondylosis.
4. Intracranial vascular ultrasound
It is used to detect intracranial artery stenosis or blockage, and helps diagnose diseases such as hypertensive encephalopathy and subarachnoid hemorrhage.
Other tests
1. Electroencephalogram
Recording brain activity to assess its functional status can help identify epileptic seizures or other neurological disorders.
2. Lumbar puncture
In certain situations, your doctor may recommend a lumbar puncture to obtain a sample of cerebrospinal fluid for further analysis.
diagnosis
Diagnostic principles
The diagnosis of occipital pain is mainly based on the location, nature, causes and accompanying symptoms of the pain, combined with a comprehensive analysis of medical history and physical signs, and laboratory tests and imaging examinations to further confirm the cause of the pain.
Differential diagnosis
1. Meningitis
Pain in the back of the head may not be the only symptom of meningitis. Patients often experience generalized pain and fullness in the brain, possibly accompanied by nausea and vomiting. Furthermore, a pulling pain in the back of the head may occur when lowering the head, a sign of meningeal irritation. A lumbar puncture and cerebrospinal fluid examination are required for diagnosis to determine the type of meningitis and the pathogen.
2. Cerebral hemorrhage
The headache associated with cerebral hemorrhage typically radiates from the back of the head to the bilateral forehead, and is particularly pronounced at night. Patients may also experience dizziness, paresthesias on one side of the limbs, and numbness and weakness. A head CT scan can help confirm the diagnosis.
3. Cerebral vasospasm
Patients experience spasmodic, paroxysmal, distending, or dull pain throughout the head, forehead, and back of the head, possibly accompanied by dizziness and vertigo. The diagnosis should consider the patient’s history of chronic cerebral ischemia and the corresponding examination results.
4. Brain tumor
Symptoms typically include pain in the skin and muscles at the back of the head on one side. This pain can be intense and electric-like. When the tumor compresses blood vessels in the back of the head, it can cause poor circulation or even blockage, leading to ischemia and hypoxia in the brain. An MRI of the brain can help detect tumors.
5. Cervical spondylosis
The headache is primarily located at the back of the head, radiating from the neck to the occipital region, top of the head, and temporal region, and can be continuous or fluctuating. The pain is relieved by pressing the neck and worsened by bowing the head for extended periods. Cervical spine X-rays or MRIs can help diagnose cervical spondylosis.
6. Occipital neuralgia
It manifests as paroxysmal severe pain on one or both sides of the back of the head, and the pain radiates to the top, temporal area, mastoid area, etc. During self-examination, there is obvious tenderness behind the occipital bone, especially at the Fengchi acupoint.
7. Temporal arteritis
Temporal arteritis primarily occurs in the elderly, particularly those over 60 years old. In addition to headaches, patients may also experience facial discomfort, pain in the temporomandibular joint, and masticatory muscles. Severe cases of temporal arteritis may also involve the ophthalmic artery, potentially threatening vision. An elevated erythrocyte sedimentation rate and a mild or moderately elevated white blood cell count may indicate temporal arteritis.
treat
Expected treatment
The treatment of back of the head pain varies according to the specific cause and severity of the pain, mainly including causal treatment, drug treatment and surgical treatment when necessary.
Treatment of the cause
1. For those caused by abnormal intracranial pressure, dehydration drugs such as mannitol, glycerol fructose, etc. should be used.
2. Patients with intracranial infection should actively receive anti-infection treatment.
3. Patients with hypertension should actively control their blood pressure.
4. For cerebrovascular diseases, brain tumors, etc., surgical treatment may be required.
5. For patients with cervical spondylosis, traction, acupuncture, physical therapy combined with analgesics and blood-activating and blood-stasis-removing drugs are generally used for treatment.
6. For patients with occipital neuralgia, drugs such as lidocaine and dexamethasone can be used for nerve block therapy, which directly acts on the occipital nerve to relieve pain, reduce inflammatory response and nerve compression.
Drug treatment
1. Nonsteroidal anti-inflammatory drugs
Such as ibuprofen, indomethacin, diclofenac, loxoprofen, celecoxib, etc. These drugs can relieve mild to moderate pain and reduce inflammatory responses.
2. Antiepileptic drugs
Drugs such as carbamazepine and gabapentin are often used to treat neuropathic pain and relieve pain by regulating neurotransmitters.
3. Muscle relaxants
For example, eperisone can relax tense muscles and relieve pain caused by muscle spasms.
4. Neurotrophic drugs
Such as B vitamins, methylcobalamin, etc., help improve neurotrophic status and promote the recovery of nerve function.
5. Antidepressants
Drugs such as amitriptyline can also be used to treat back of the head pain in some specific cases.
Related drugs
Ibuprofen, indomethacin, diclofenac, loxoprofen, celecoxib, carbamazepine, gabapentin, eperisone, methylcobalamin, amitriptyline
Surgical treatment
1. Minimally invasive surgery
For neuropathic posterior brain pain, minimally invasive surgical methods such as pulsed radiofrequency, radiofrequency ablation and low-temperature plasma ablation can be used to treat the occipital nerve or cervical nerve and intervertebral disc through neuromodulation and other methods.
2. Other surgeries
For neuropathic occipital pain that is difficult to relieve with minimally invasive surgery, other surgical methods such as occipital nerve decompression, simple occipital nerve section, and inferior oblique muscle section can also be used to relieve the pain.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.