The greater occipital nerve runs between the first and second cervical vertebrae to the top of the scalp. A greater occipital nerve exists on both the right and left side of the neck, along with lesser occipital nerves. This nerve extends almost to the forehead and permits sensations on the scalp.

Disorders of the greater occipital nerve might create stabbing, burning, or tingling pain that radiates to the eye. In some patients, the scalp becomes ultra sensitive to any kind of touch, making it difficult for them to wash their hair or rest on a pillow. This condition is called occipital neuralgia and occurs in three forms.

Long-term pain and discomfort might resemble a tension headache with pain in the back of the neck and head. The greater occipital nerve might be tender to the touch and can affect one or both sides of the head. Muscles in the neck might be stiff, and pain typically spreads to the forehead and near the eye.

The second form of occipital neuralgia produces migraine headaches marked by intense pain lasting between two and 36 hours. It may stem from inflammation of the greater occipital nerve that starts on one side of the head and spreads to the other side. Some people suffer nausea and vomiting with a migraine, along with sensitivity to light. Doctors might call this disorder migraine involving the greater occipital nerve instead of occipital neuralgia.

Occipital neuralgia involving the greater occipital nerve can occur from injury, a tumor, inflammation, or pressure on the nerve when it becomes compressed. Tension in the neck might precipitate a pinched nerve, leading to pain. These conditions might cause the scalp to become extremely tender and result in frequent headaches.

Treatment typically involves a greater occipital nerve block to deaden sensation to the scalp. An injection of anesthesia and steroids might numb pain and address swelling. The anesthesia generally wears off in a few hours, but steroids usually start relieving pain in a few days. Some patients need additional injections to control pain, but doctors generally limit nerve block treatments to no more than three within six months.

If nerve block injections fail to control discomfort, several other treatments might be sought. The occipital nerve can be cut to permanently block sensation to the head. Injections of a toxin might kill nerve cells causing pain, or radio waves might deaden nerves. Another option involves implantation of a nerve stimulator, similar to a pacemaker, that converts pain to a tingling sensation. These treatments might cause permanent numbness to the scalp region.