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Pressure in the Back of Head

Pressure in the Back of Head

The common contributing factors for the sensation of pressure in the back of the head include tension headaches, migraines, cervicogenic headaches, or inflamed sinuses. This HealthHearty write-up provides information on these medical conditions.
Smita Pandit
Last Updated: May 20, 2018
About 12 percent of the population of the United States is affected by migraines, which is a type of vascular headache that usually affects one side of the head, but may spread to the back of the head.
Medically referred to as cephalalgia, a headache is characterized by pain or discomfort in the head or neck. A common ailment affecting people of all age groups, headaches could be caused due to a wide range of reasons. It must be noted that such a pain is experienced, when any of the nociceptors (pain receptors) located in certain organs or structures of the head or neck (eyes, ears, sinuses, muscles, arteries, veins, mucous membranes, or tissues under the skin) get stimulated and send pain signals to the nerve cells in the brain.
The International Headache Society classifies headaches into three categories. The first two categories are primary and secondary headaches, and the third category includes cranial neuralgias, central and primary facial pain, and other headaches. Primary headaches are idiopathic in nature, which means that these are not caused by any underlying medical condition. Migraine, tension-type headaches, and cluster headaches are placed in this category. These are more common than the secondary headaches, which are associated with medical conditions. The serious causes of secondary headaches include brain tumors, aneurysm, intracranial hemorrhage, intracranial pressure, temporal arteritis, etc. In some cases, the pain might be of a cervical origin.
Contributing Factors
The analysis of the characteristics and location of the pain can help the doctors zero in on the probable cause of discomfort, which can then be confirmed with the help of diagnostic imaging procedures. For instance, pain or pressure in the back of the head could be indicative of migraines, cervicogenic headaches, or tension-type headaches.
Cervicogenic Headaches
As the name suggests, cervicogenic headaches are headaches of the cervical origin. The cervical spine is the part of the spine that is located near the base of the skull. Often caused in the event of excessive, persistent pressure to the neck and the spine, such headaches originate in the neck and spread to the oculofrontal-temporal areas of the head. Pain might also be felt in this region due to the trauma to the spine due to a whiplash injury, compression of cervical nerves due to bony growths, or herniated intervertebral disc in the cervical spine. The pain might be intermittent at first, but might later become constant. More often than not, such headaches are caused by musculoskeletal dysfunction in the cervical spine. In the event of persistent stress to the neck joint, pain messages are referred to a pathway called trigeminocervical nucleus in the brain. The characteristic symptoms of such headaches include:

Pain that is triggered or aggravated by neck movement
Pain that is triggered due to an awkward position of the neck
Pain that is referred from the cervical spine or the soft neck tissues to the head
Restricted range of motion of the neck
Stiffness of the neck
Ipsilateral shoulder or arm pain

Since the pain gets exacerbated due to certain neck movements or positions, the affected person should not perform activities that involve such motions. The use of painkillers, muscle relaxants, physiotherapy, spinal manipulation, etc., can help in the treatment of such headaches.
Migraine is a type of vascular headache that affects more than 37 million Americans. Women are more susceptible to this condition than men. Earlier, it was believed that migraines were caused by the dilatation of blood vessels and the aura (certain symptoms that are felt before the attack in some cases) occurred due to vasconstriction. This theory is no longer considered to be correct. It is now believed that this vascular headache might be due to a primary neuronal dysfunction. Only 15% of people affected by this condition might experience aura, which might be characterized by the following symptoms:

Colored spots
Blind spots
Sparkles or flashing lights
Zigzag lines or patterns
Spinning sensation
Numbness or tingling sensation

This stage might last anywhere between 5 and 30 minutes. Thereafter, the affected person would experience pain that worsens with physical activity. The pain might be unilateral or bilateral, or could even be felt at the top or back of the head. The characteristic symptoms that are felt during an attack include:

Pulsating/throbbing pain in the head
Increased sensitivity to light and sound

The affected person might feel tired, irritable, and weak even after the headache has resolved. A feeling of soreness might be felt in the area where pain was felt. The attacks could be triggered by changes in the sleep-wake cycle, stress, the use of drugs that cause blood vessels to swell up, exposure to bright lights or fluorescent lights, consumption of certain food items, or excessive noise. Therefore, the treatment usually involves the avoidance of the triggers and the use of certain abortive drugs (Almotriptan, Naratriptan, Excedrin, Advil Migraine, and Motrin Migraine), anti-inflammatory agents, etc.
Tension-type Headaches
Tension-type headaches occur when the muscles in the neck and the scalp become tense or contract. These may last anywhere between 20 minutes to 6 hours. Not as severe as migraines, these are characterized by a dull pain that is usually mild to moderate in intensity. However, the symptoms might be severe in some cases. It is believed that the contributing factors for such muscle contractions could be stress, head trauma, bruxism, bad posture, depression, or anxiety. The characteristic symptoms of such headaches include:

A feeling of pressure or hatband tightness in the back of head and neck
Dull, squeezing pain
Pain at the temples
Pain at the back of the head or the neck

These headaches are referred to as chronic, if they occur more than 15 days a month for a period of six months. Otherwise, they are called episodic. The treatment of chronic headaches involves the use of a tricyclic antidepressant called amitriptyline. Other antidepressants that might be prescribed include mirtazapine or venlafaxine. In case of episodic tension-type headaches, the use of analgesics might suffice. Deep breathing exercises, massage, or other relaxation techniques might also prove beneficial.
Sinus Pressure
Sinuses are four pairs of air-filled spaces (frontal sinuses, maxillary sinuses, sphenoid sinuses, and ethmoid sinuses) that lie within the skull. Each of these air-filled cavities connects to the nasal cavity through a small opening called ostium. Sinuses are lined with membranes that secrete mucus and moisten the nasal passages. Sinuses also help in filtering out dust, pollutants, and pathogens that may be present in the air that we inhale. Allergies or cold can cause inflammation or swelling of nasal membranes. This leads to the blockage of the ostia. When mucus does not drain out, it causes pressure to build up inside the sinuses. This gives rise to sinus pressure or headaches. The inflammation of sphenoid sinuses that are located deep in the skull could give rise to sinus pressure in the back of head. This condition might cause the following symptoms:

Pressure or pain at the top or back of the head
Ear pain
Neck pain
Nasal congestion
Pain when bending over or lying down

However, the incidence of sphenoiditis is less common than other types of sinusitis. The treatment of sinus pressure usually involves the use of analgesics, antipyretics, specific drugs for inhibiting the growth of the causal pathogen, sinus drainage procedure, etc. Once the infection resolves, the pain in the head will also disappear.
Occipital Neuralgia
Occipital neuralgia is characterized by damage to the occipital nerves, which are a pair of nerves originating from the second and third vertebrae of the spinal column. These nerves supply the top and the back of the head, which is why occipital neuralgia gives rise to pain in this region of the head. The pain might be intermittent or continuous. It can be acute or chronic. Acute continuous attacks may last for several hours. In chronic cases, the affected individual might also experience localized muscle spasms. Trauma to the neck or back of the head, infections, spinal column compression, tumors, or osteoarthritis of the neck could cause this condition. In some cases, the underlying cause may not be identified. The common symptoms include:

Piercing pain in the back of the head (mostly unilateral)
Scalp tenderness
Restricted range of motion of the neck
Pain that is exacerbated by certain positions
Pain might be referred to the face

The treatment of this condition includes rest and drug therapy. Steroids, nerve block injections, painkillers, antidepressants (in severe cases), anti-inflammatory drugs, and muscle relaxants are usually prescribed.
Besides the aforementioned conditions, temporal arteritis (a condition characterized by the inflammation of the large and medium arteries that supply the head) can also cause pain in the back or one side of the head. It is believed that this condition might occur due to a faulty immune response. Besides headaches, this condition might also give rise to flu-like symptoms, vision problems, tenderness of the scalp, etc. Since headaches could also occur due to certain serious conditions that need immediate medical attention (tumors, meningitis, increased intracranial pressure caused by the buildup of cerebrospinal fluid around the brain, vertebral artery dissection, etc.), persistent posterior headaches must not be ignored. Medical assistance must be sought to diagnose and treat the underlying cause at the earliest.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.