Occipital Neuralgia Care in Redmond, WA
Gentle NUCCA upper cervical care for sharp, shooting pain at the base of the skull. No twisting, no cracking.
Occipital neuralgia causes sharp, shooting or electric-shock pain that starts at the base of the skull and travels up the back of the head. For many people, even brushing their hair or resting their head on a pillow can set it off.
The nerves involved begin in the upper neck, right where the top two vertebrae meet. At Back In Balance, Dr. Justin Schallmann, DC, uses gentle NUCCA upper cervical chiropractic to address alignment and muscle tension in that region, with no twisting, no cracking and no popping. We work alongside your physician or neurologist, who confirms the diagnosis and manages medical treatment.
What Is Occipital Neuralgia?
Occipital neuralgia is a type of nerve pain affecting the occipital nerves, which carry sensation from the upper neck to the back of the scalp. The International Headache Society classifies it as a distinct condition, separate from migraine and tension headaches.
01 · Greater Occipital Nerve
Involved in about 90% of cases. It comes from the C2 nerve root and runs up the back of the head toward the top of the scalp.
02 · Lesser Occipital Nerve
Runs along the side of the head behind the ear. It is involved in most of the remaining cases.
03 · Third Occipital Nerve
A smaller nerve from the C2–C3 level that supplies the lower back of the head. It is involved less often.
Diagnosis is made by a physician. Under the international criteria, the diagnosis is confirmed when a local anesthetic nerve block temporarily relieves the pain.
Common Symptoms
- Sharp, stabbing, shooting or electric-shock pain at the base of the skull
- Pain that travels up the back of the head, sometimes toward the top of the head or behind the eye
- Pain on one side or both sides
- Aching or throbbing between the sharp attacks
- Tenderness at the base of the skull
- Scalp sensitivity, where light touch, brushing hair or a pillow triggers pain
- Pain triggered by neck movement or holding your head in one position
- Numbness or tingling over the back of the scalp
Red Flags: Seek Medical Care Right Away
Pain at the back of the head can have serious causes. Call 911 or go to an emergency room for:
- A sudden, severe headache unlike anything you've had before
- Headache with fever, a stiff neck, confusion or a rash
- New weakness, numbness, vision changes, slurred speech or loss of balance
- Headache after a significant head or neck injury
See your doctor promptly for a new headache after age 50 (especially with scalp tenderness, jaw pain when chewing or vision changes), or for a painful rash on the scalp or neck, which can be shingles.
Common Causes
Occipital neuralgia happens when the occipital nerves become irritated, compressed or inflamed. Often no single cause is found. Contributing factors include:
- Muscle tightness in the suboccipital and upper neck muscles that the nerves pass through
- Neck injury, including whiplash, falls and sports injuries
- Sustained postures such as forward head posture and long hours at a screen
- Upper cervical joint problems, including arthritis at the C1–C2 or C2–C3 joints
- Previous head or neck surgery
- Less common causes that a physician must rule out, including shingles, nerve tumors, blood vessel problems and Chiari malformation
Why the Upper Neck Matters
The greater occipital nerve begins at the C2 level, just below the atlas (C1). On its way up to the scalp, it wraps around and passes through small muscles that connect the skull, the atlas and the axis (C2), including the obliquus capitis inferior and the semispinalis capitis.
When the head and upper neck sit out of balance, these muscles can stay tight and guarded. That tension, along with altered joint mechanics at C1–C2, may add pressure or irritation along the nerve's path. This is why occipital neuralgia frequently overlaps with neck pain and cervicogenic headaches, and why it often follows whiplash.
How NUCCA Chiropractic May Help
NUCCA (National Upper Cervical Chiropractic Association) care is a precise, low-force chiropractic approach focused on the alignment of the head and upper neck, the same region where the occipital nerves begin. For irritated nerves and sensitive scalps, a gentle approach matters.
No Twisting
Your neck is never rotated or pushed to end range. You lie comfortably on your side.
No Cracking
No high-velocity thrust and no "pop." Just light, controlled hand contact behind the ear.
Precision Imaging
Upper cervical x-rays measure the exact direction and amount of misalignment.
Gentle Contact
Light enough to be comfortable even when the back of your head is tender.
NUCCA Care May Help
- Reduce upper neck muscle tension along the nerve's path
- Restore more balanced head and upper neck alignment
- Ease related neck pain and cervicogenic headaches
- Support recovery when symptoms began after whiplash or a fall
NUCCA Care Does Not
- Diagnose occipital neuralgia (your physician does)
- Replace nerve blocks, medications or other medical treatment
- Treat occipital pain caused by shingles, tumors or blood vessel problems
- Repair nerve damage from surgery or advanced arthritis
What to Expect
Free consultation: Every new patient starts with a free consultation with Dr. Schallmann to review your symptoms, your diagnosis and treatments so far, and whether NUCCA care is a good fit. The examination and x-rays are not part of the consultation. They are separate services with their own fees, and we'll explain all costs before anything is done.
Visits 1 and 2 (1 hour each): If you move forward, your first visit includes an examination and precision upper cervical x-rays. Your second visit reviews the findings and includes your first gentle NUCCA correction.
Weeks 1–4, calming things down: Short visits (about 15 minutes) focus on establishing a stable alignment. You're only adjusted when your checks show a correction is needed.
Months 2–3, building stability: As your alignment holds longer, visits become less frequent. We track changes in the frequency and intensity of your attacks.
Ongoing: Many patients move to periodic check-ups and come in after a flare or new injury.
When You May Need Other Providers
Occipital neuralgia is often best managed by a team. Depending on your situation, that may include:
- Primary care physician or neurologist to confirm the diagnosis and rule out other causes
- Pain management specialist for occipital nerve blocks, Botox injections or pulsed radiofrequency treatment
- Physical therapist for posture, deep neck flexor strengthening and soft tissue work
- Neurosurgeon for rare cases that don't respond to conservative care, including occipital nerve stimulation or decompression
- Massage therapist for suboccipital and upper neck muscle tension
Common medical treatments include anti-inflammatory medications, nerve pain medications such as gabapentin or pregabalin, and nerve blocks, which can also confirm the diagnosis. We're glad to coordinate with your other providers and share findings with your permission.
When NUCCA May Not Be the Right Fit
- Your pain hasn't been evaluated by a physician and you have any of the red flags above
- Your occipital pain is caused by shingles, a tumor, infection or a blood vessel problem
- You have a new headache after age 50 that hasn't been checked for giant cell arteritis
- Your symptoms are getting rapidly worse or include new neurological symptoms
- Your pain is clearly coming from nerve damage after surgery, which typically needs specialist care
What the Research Shows
Occipital neuralgia is well defined, but research on its causes and conservative treatment is still limited. There are no clinical trials yet on NUCCA care specifically for occipital neuralgia. Our approach is based on the nerve's well-documented anatomy in the upper neck and on its overlap with cervicogenic headache.
Headache Classification Committee of the International Headache Society (2018)
The International Classification of Headache Disorders, 3rd edition (ICHD-3).
Cephalalgia, 38(1):1–211.
The international diagnostic standard. It defines occipital neuralgia and requires temporary relief from a local anesthetic nerve block to confirm the diagnosis.
Barmherzig R, Kingston W (2019)
Occipital Neuralgia and Cervicogenic Headache: Diagnosis and Management.
Current Neurology and Neuroscience Reports, 19(5):20.
Reviews the significant overlap between occipital neuralgia and headaches originating from the neck, and how each is diagnosed and managed.
Choi I, Jeon SR (2016)
Neuralgias of the Head: Occipital Neuralgia.
Journal of Korean Medical Science, 31(4):479–488.
Describes the anatomy of the occipital nerves, including where they pass through upper neck muscles, and the range of treatment options from medication to surgery.
StatPearls: Occipital Neuralgia
National Library of Medicine, NCBI Bookshelf.
A clinical overview of the evaluation, diagnosis and team-based management of occipital neuralgia.
Research findings describe groups of patients, not guaranteed individual outcomes. Your evaluation will determine whether NUCCA care is appropriate for you.
Frequently Asked Questions
Can a chiropractor help with occipital neuralgia?
Chiropractic care may help when upper neck alignment and muscle tension contribute to irritation of the occipital nerves. NUCCA care addresses the head and upper neck with gentle, precise corrections. It works best alongside your physician, who confirms the diagnosis and manages medical treatment.
Will you crack my neck?
No. NUCCA corrections use light hand pressure with no twisting, thrust or popping, which matters when the back of your head and neck are already sensitive.
How is occipital neuralgia different from a migraine?
Occipital neuralgia causes brief, sharp, shooting or electric pain in the path of the occipital nerves. Migraines usually cause throbbing pain lasting hours to days, often with nausea and sensitivity to light or sound. The two can overlap, and a physician can help tell them apart. See our Migraines page.
Do I need a diagnosis before coming in?
It helps, but it isn't required. If you haven't been evaluated and have any red-flag symptoms, please see a physician first. If your history suggests occipital neuralgia, we'll recommend appropriate medical evaluation alongside your care.
Can I have NUCCA care if I'm getting nerve blocks?
Yes. Many patients use both. Nerve blocks calm the nerve directly, while NUCCA care focuses on the alignment and muscle tension of the upper neck. Let both providers know about all of your treatments.
Can whiplash cause occipital neuralgia?
Yes. Neck injuries from car accidents, falls and sports are a common trigger, because they can strain the upper neck muscles and joints the occipital nerves pass through. Learn more on our Auto Injuries / Whiplash page.
How long does it take to feel better?
It varies. Some patients notice changes within the first few weeks, while others need longer, especially after an injury or with long-standing symptoms. We track the frequency and intensity of your attacks and will tell you honestly if NUCCA care isn't helping.
Is occipital neuralgia dangerous?
Occipital neuralgia itself is not life-threatening, though it can be very painful. Other, more serious conditions can cause pain at the back of the head, which is why a medical evaluation is important, especially for a sudden or severe headache.
Is the first consultation really free?
Yes. Every new patient starts with a free consultation. The examination and x-rays are not part of it. They are separate services with their own fees, and we'll explain all costs before anything is done.
Related Conditions
- Headaches
- Migraines
- Neck Pain
- Auto Injuries / Whiplash
- Post-Concussion Syndrome
- Craniocervical Instability (CCI)
- Trigeminal Neuralgia
- Numbness and Tingling
- Posture
- Gentle Chiropractic
Gentle Care for Pain at the Base of the Skull
If occipital neuralgia is disrupting your days or your sleep, start with a free consultation to see whether NUCCA upper cervical chiropractic is a good fit for you.
Dr. Justin Schallmann, DC, is NUCCA Part 2 Certified and one of about 300 doctors trained in NUCCA worldwide.