Causes of Headache in the Back of the Head (Occipital Region)

• Tension-type headache - most common cause; bilateral, band-like or pressing pain often centered in the occipital/suboccipital and neck muscles, linked to stress, poor posture, and prolonged static postures.
• Cervicogenic headache - pain referred from the upper cervical spine (C1-C3 structures, joints, muscles, ligaments) into the occipital and sometimes frontal/temporal region; worsens with neck movement or sustained neck posture, and is frequently misdiagnosed as migraine because of symptom overlap (Bradley and Daroff's Neurology in Clinical Practice).
• Occipital neuralgia - sharp, shooting, electric-shock-like pain in the distribution of the greater/lesser occipital nerves, often with scalp tenderness or numbness; usually from chronic neck muscle tension but can also follow trauma, or rarely a structural/infiltrating lesion (Bradley and Daroff's Neurology in Clinical Practice, p. 1040-1051).
• Migraine - can localize occipitally in some patients despite the classic fronto-temporal pattern.

• Cervical spondylosis, degenerative disc disease, whiplash or neck trauma.
• Poor workstation ergonomics / prolonged screen or downward-gaze work ("tech neck"), repetitive occupational neck strain (driving, overhead work, vibration exposure).
• Muscle tension from stress or sustained awkward posture.
• Craniovertebral junction abnormalities (Chiari I malformation, atlantoaxial subluxation, basilar invagination) - rare but important in persistent cases.
• Cervical spine arthritis (rheumatoid arthritis, ankylosing spondylitis).
• Severe/uncontrolled hypertension.
• Medication-overuse headache from frequent analgesic use.

Management at an Occupational Health Centre (OHC)

1. Triage for red flags first. Check vitals (BP, temperature), do a brief neuro exam, and ask about sudden severe onset, fever, trauma, or neurological symptoms. Any red flag = refer out for urgent imaging/specialist care rather than treat symptomatically.
2. Focused history and exam. Character, onset, frequency, aggravating/relieving factors, relation to neck posture/movement, work tasks (screen time, machine operation, manual lifting, vibration, overhead work, noise/heat exposure), sleep, stress, and analgesic use pattern. Palpate cervical paraspinal and suboccipital muscles and check neck range of motion for cervicogenic/tension patterns.
3. First-line symptomatic treatment (for uncomplicated tension-type/cervicogenic headache):
   • Simple analgesics (paracetamol) or a short course of NSAIDs.
   • Limit analgesic use to fewer than 2-3 days/week to avoid medication-overuse headache.
   • Local heat/cold application to the neck, gentle stretching, and rest breaks.
4. Ergonomic and occupational correction - this is where OHC management adds real value beyond symptomatic treatment:
   • Adjust workstation (monitor height, chair, keyboard position) to keep neck neutral.
   • Schedule regular micro-breaks for employees with prolonged static postures or repetitive neck strain.
   • Modify tasks involving sustained neck flexion/extension, vibration, or overhead work where feasible.
   • Provide posture and stress-management education; encourage neck/shoulder stretching exercises.
5. Refer for physiotherapy if cervicogenic headache or occipital neuralgia is suspected - manual therapy and neck-strengthening exercises have evidence for symptom reduction; a greater/lesser occipital nerve block can be considered by a specialist for refractory occipital neuralgia (Bradley and Daroff's Neurology in Clinical Practice).
6. Escalate/refer to a physician or neurologist if:
   • Headache is recurrent, disabling, or unresponsive to conservative measures after a reasonable trial.
   • There is diagnostic uncertainty, suspected structural cause, or red flags emerge on follow-up.
   • Cervical spine or brain imaging (MRI) is needed, which is not something an OHC can typically arrange.
7. Document and follow up. Record the episode, treatment given, and any work modification advised; reassess at follow-up visit and consider occupational reassignment if a specific job task is a recurring trigger.