Regional muscle reference; this is not an individual map of the selected numbered trigger point.
Pain referral. Back of head, occipital region
Pain Pattern
Back of head
Upper neck
Behind eyes
What This Pain Feels Like
This trigger point produces a diffuse, aching pain at the back of the skull that wraps upward toward the top of the head. Patients often describe it as a heavy pressure or band-like sensation across the entire back of the head that can be difficult to pinpoint. The pain typically worsens when lying on your back or pressing the back of your head against a pillow, chair, or headrest. It is frequently confused with a tension headache because the pain pattern is so similar, but the distinguishing feature is tenderness in the occipitalis muscle itself at the back of the skull.
What Patients Report
Pain at back of head
Headache that starts at neck
Scalp sensitivity
What Makes It Worse
Neck extension
Stress
Prolonged sitting
Looking down at phone
An exercise should be chosen for your symptoms and movement needs. The care options below can help guide the next step.
Symptoms patients report
Occipital headache Aching pain at the back of the skull radiating upward toward the vertex
Scalp tenderness Heightened sensitivity of the occipital scalp to touch or pressure
Pain at base of skull Deep ache at the occipital ridge where the muscle attaches to bone
Pain behind ear mistaken for ear pathology Occipitalis trigger points near the mastoid refer to the retroauricular area mimicking ear disease
Posterolateral headache Referral creates a posterolateral cranial headache pattern behind and above the ear
Tenderness at skull base laterally Taut bands at the lateral occipital attachment create palpable tenderness along the nuchal line
Scalp sensitivity behind ear Central sensitization from trigger point referral increases scalp sensitivity in the retroauricular zone
Difficulty lying on affected side Lateral recumbent position compresses trigger points against the pillow provoking retroauricular pain
Common causes
Tension Chronic muscle tension from stress creates sustained occipitalis contraction and ischemia
Forward head posture Sustained neck positions can aggravate discomfort at the back of the head. The occipitalis moves the scalp; neck muscles support and move the head.
Place both hands behind your head with your fingertips at the base of your skull where it meets the neck. Using your fingertips, apply firm but comfortable pressure in small circular motions along the ridge at the bottom of the skull. Work from the center outward toward the ears, spending extra time on any tender spots. Hold sustained pressure on each tender point for 20-30 seconds until you feel the tension release.
Duration
3-5 minutes per session
Frequency
2-3 times daily, especially when headache symptoms are present
Expect
May temporarily ease local neck tenderness and make comfortable movement easier.
Immediate Relief
Tennis ball release at skull base
Lie on your back on a firm surface and place a tennis ball under the base of your skull where you feel tenderness. Allow the weight of your head to create pressure on the ball. Slowly turn your head slightly left and right to massage different areas along the skull base. When you find a particularly tender spot, hold still and breathe deeply for 30 seconds. Adjust the ball position to cover the entire occipital ridge.
Duration
5-10 minutes per session
Frequency
1-2 times daily, especially before bed
Expect
May temporarily ease local neck tenderness and make comfortable movement easier.
Exercises
Neck stretches for occipital relief
Sit tall in a chair and gently tuck your chin toward your chest, feeling a stretch at the back of your neck and base of your skull. Hold for 20 seconds. Next, gently tilt your head to one side, bringing your ear toward your shoulder until you feel a stretch on the opposite side. Hold for 20 seconds and repeat on the other side. Finally, place both hands behind your head and gently pull your chin further toward your chest for an enhanced stretch of the occipital area.
Duration
20 seconds per stretch, complete all three directions
Frequency
3-4 times daily, especially after prolonged sitting or screen time
Expect
Aims to improve comfortable neck movement for turning, looking and daily tasks.
Exercises
Chin tucks for postural correction
Sit or stand with your back straight and shoulders relaxed. Without tilting your head up or down, gently glide your chin straight back as if making a double chin. You should feel a gentle stretch at the base of your skull and a lengthening of the back of your neck. Hold for 5 seconds, then relax. The movement is small and controlled, focusing on retracting the head over the shoulders rather than looking down.
Duration
10 repetitions, holding each for 5 seconds
Frequency
3-4 times daily, and every 30-60 minutes during desk work
Expect
Practises controlled neck movement; progress is judged by comfort and task tolerance.
Lifestyle Changes
Pillow and sleep positioning adjustment
Choose a pillow that supports the natural curve of your neck without pushing your head too far forward or letting it fall too far back. When sleeping on your back, use a pillow that fills the space between your neck and the mattress while keeping your head in a neutral position. Consider a contoured cervical pillow with a built-in neck roll. If you sleep on your side, ensure the pillow thickness matches your shoulder width. Avoid sleeping on very firm or flat pillows that increase pressure on the back of the skull.
Duration
Ongoing nightly adjustment
Frequency
Every night, reassess pillow suitability monthly
Expect
Aims to reduce uncomfortable pressure or neck positioning during sleep.
Professional Treatment
Professional evaluation for persistent occipital headaches
If occipital headaches persist despite 2-3 weeks of self-care, consult a healthcare professional experienced in myofascial pain or headache management. A physical therapist can perform targeted manual therapy including sustained pressure release and dry needling of the occipitalis. A physician can rule out occipital neuralgia, cervicogenic headache, or other neurological causes. Bring a headache diary noting frequency, duration, triggers, and what makes the pain better or worse.
Duration
Initial evaluation typically 45-60 minutes
Frequency
As recommended by the provider, typically weekly for 4-6 sessions initially
Expect
A headache assessment and a treatment plan matched to the diagnosis and daily limitations.
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