Pain at the base of your skull—where your head meets your neck—is one of the most common headache locations, and there’s good reason for it. This area is a nexus of muscles, nerves, and joints that work constantly to support your head, allow neck movement, and transmit signals between your brain and body. When any of these structures become strained, irritated, or inflamed, you feel it right at the back of your head.
The good news is that most headaches at the base of the skull stem from treatable causes like muscle tension, poor posture, or neck problems. Understanding what’s behind your pain empowers you to find relief—whether through simple self-care or, when needed, professional treatment. While most causes are benign, knowing the warning signs of more serious conditions helps you recognize when to seek immediate medical attention.
Track your neck and headache symptoms
Pain at the base of the skull often relates to neck position, posture, and muscle tension. Our symptom tracker helps you log when headaches occur, what activities or positions preceded them, and what provides relief. Tracking neck stiffness, posture habits, and sleep position alongside headache episodes can reveal important patterns. Share this information with your healthcare provider if your headaches persist.
What causes headaches at the base of the skull?
The base of your skull—the occipital region—contains multiple structures that can generate pain. Understanding these helps identify your specific cause.
Tension-type headache
Tension headaches are the most common headache type worldwide, and they frequently affect the back of the head. The muscles that attach at the base of your skull (including the suboccipital muscles, trapezius, and splenius) can become tight and painful from stress, sustained postures, or fatigue [1].
Characteristics:
- Dull, aching, or pressing pain
- Often feels like a band wrapping from the back of head to forehead
- Bilateral (both sides)
- Mild to moderate intensity
- May come with neck and shoulder tightness
- Often worse at end of day
Cervicogenic headache
These headaches originate from problems in the cervical spine (neck) but cause pain that’s felt in the head. The upper neck contains nerve pathways that converge with head pain pathways in the brainstem, allowing neck problems to “refer” pain to the head [2].
Characteristics:
- Pain often starts in neck and radiates to base of skull and beyond
- Worsens with certain neck movements or sustained positions
- Often one-sided (though can be bilateral)
- Reduced neck range of motion
- Tender points in neck muscles
- May improve temporarily with neck treatments
Common causes:
- Poor posture (forward head position)
- Neck injury or whiplash
- Cervical disc problems
- Arthritis of the cervical spine
- Prolonged awkward positions
Occipital neuralgia
The occipital nerves emerge from the upper spine and travel upward through the muscles of the neck to the scalp. When these nerves become compressed, inflamed, or irritated, they produce a distinctive type of pain [3].
Characteristics:
- Sharp, shooting, or electric-shock-like pain
- Starts at base of skull and shoots upward
- May affect one or both sides
- Scalp often becomes tender to touch
- Pain may be triggered by neck movement
- Episodes can be brief but intense
Causes include:
- Tight neck muscles compressing the nerve
- Neck injury or trauma
- Prolonged head-forward posture
- Cervical arthritis
- Sometimes occurs without identifiable cause
Poor posture and “tech neck”
Modern life has created an epidemic of posture-related neck and headache problems. When you look down at a phone or lean toward a computer screen, your head shifts forward of your shoulders. Since the average head weighs 10-12 pounds, this position dramatically increases the strain on your neck muscles [4].
This forward head posture:
- Overworks the muscles at the base of skull
- Compresses structures in the upper neck
- Creates chronic tension that leads to headaches
- Often causes pain that’s worst at end of workday
Arthritis (cervical spondylosis)
Age-related changes in the neck—including disc degeneration, bone spurs, and joint arthritis—can cause chronic pain at the base of skull. This typically develops gradually in adults over 50.
Characteristics:
- Chronic, aching pain
- Neck stiffness, especially in the morning
- May include grinding or popping sensations
- Gradually worsens over time
Other causes
Chiari malformation: A structural condition where brain tissue extends into the spinal canal. Causes headaches at base of skull that worsen with coughing or straining.
High blood pressure: Severely elevated blood pressure can cause headaches at the back of the head, often noticed upon waking.
Meningitis: Infection of the membranes around the brain causes severe headache with stiff neck and fever. This is a medical emergency.
What does a headache at the base of skull feel like?
| Cause | Sensation | Key Features |
|---|---|---|
| Tension headache | Dull, pressing, band-like | Bilateral, with neck tightness |
| Cervicogenic | Aching, may radiate | Starts in neck, movement-triggered |
| Occipital neuralgia | Sharp, shooting, electric | Radiates upward, scalp tender |
| Arthritis | Chronic aching, stiffness | Morning stiffness, grinding |
| Postural | Aching, worse with time | Builds throughout day |
How can I find relief from base-of-skull headaches?
Most headaches at the base of skull respond well to conservative treatment. The key is addressing the underlying cause.
For muscle tension and posture-related pain
Immediate relief:
- Heat therapy: Warm compress or heating pad on neck and base of skull
- Gentle stretching: Chin tucks, neck rotations, shoulder rolls
- OTC pain relievers: Ibuprofen, naproxen, or acetaminophen
- Massage: Self-massage of neck muscles or professional treatment
Preventive strategies:
- Posture correction: Keep ears aligned over shoulders; avoid forward head position
- Ergonomic workspace: Monitor at eye level, chair at proper height
- Take breaks: Every 30-60 minutes, look up and move your neck
- Strengthen neck muscles: Targeted exercises improve support
- Stress management: Tension often relates to stress
For cervicogenic headaches
- Physical therapy: Targeted exercises, manual therapy, and posture training
- Postural changes: Address forward head position
- Ergonomic improvements: At work and home
- Heat or ice: Experiment to see which helps more
- Prescription options: Muscle relaxants or trigger point injections for severe cases
For occipital neuralgia
- Heat therapy: Warm compress on base of skull
- Massage: Gentle massage of neck and suboccipital muscles
- OTC anti-inflammatories: May reduce nerve irritation
- Posture improvement: Reduce positions that compress the nerves
- Occipital nerve blocks: Healthcare providers can inject local anesthetic for significant relief
- Physical therapy: Techniques to reduce nerve compression
Stretches for base-of-skull tension
Chin tuck:
- Sit or stand with good posture
- Gently draw your chin backward (like making a “double chin”)
- Hold for 5 seconds
- Repeat 10 times
Neck rotation:
- Slowly turn your head to look over one shoulder
- Hold for 15-30 seconds
- Return to center, repeat on other side
- Do 2-3 times each side
Suboccipital release:
- Place two tennis balls in a sock
- Lie down with balls at base of skull
- Let the weight of your head rest on the balls
- Relax for 5-10 minutes
When should I see a doctor?
Seek emergency care immediately if you have:
- Sudden, severe headache (thunderclap)—worst headache of your life
- Fever with stiff neck—possible meningitis
- Headache after head or neck injury—possible trauma
- Neurological symptoms—weakness, numbness, vision changes, confusion
See a doctor soon if:
- Headaches are frequent (more than twice weekly)
- Pain is progressively getting worse over weeks
- Home treatments aren’t providing adequate relief
- You have significant neck stiffness limiting movement
- Headaches are affecting your quality of life
- You’re over 50 with new headache pattern
- Pain worsens with coughing, sneezing, or straining
Living with base-of-skull headaches
Headaches at the base of your skull, while common and often frustrating, are usually caused by treatable conditions. The neck-headache connection is well-established, which means that addressing neck tension, posture, and muscle health often provides significant relief.
Start with the fundamentals: evaluate your posture (especially during screen time), apply heat to tense muscles, try gentle stretching, and take OTC pain relievers when needed. If you work at a desk, make ergonomic adjustments and take regular breaks to move your neck.
For persistent headaches—especially those with sharp, shooting pain suggesting occipital neuralgia, or headaches clearly triggered by neck movement—a healthcare provider can offer targeted treatments like physical therapy, nerve blocks, or other interventions.
The base of your skull may be where you feel the pain, but the source is often fixable. With the right approach, relief is within reach.