Occipital neuralgia is a condition involving irritation of the occipital nerves and is often characterized by sharp, shooting, burning, or electric-like pain that starts near the base of the skull and radiates upward. A 2025 study of 212 patients with occipital neuralgia found that 117 reported a prior head or neck injury, with whiplash identified as the most common cause. Let’s look at how a history of whiplash may influence the risk of occipital neuralgia.

The greater occipital nerve originates from the second cervical spinal nerve and passes through several layers of muscle and connective tissue before reaching the scalp. During a whiplash injury, the rapid back-and-forth motion of the head and neck may stretch or compress the nerve, cause microscopic injury, or trigger abnormal nerve signaling. In some individuals, these changes may contribute to the shooting, burning, or electric-like sensations.

Whiplash commonly causes tightness in the small muscles at the base of the skull as well as tension throughout the neck and shoulders. When these muscles remain chronically tight, they may place pressure on nearby occipital nerves and contribute to symptoms. Trauma can also affect the joints between the skull and first cervical vertebra as well as those between the first and second cervical vertebrae. These structures are closely related to the nerve roots that eventually form the occipital nerves. Joint irritation may increase local inflammation, alter nerve mechanics, and produce pain patterns that resemble occipital neuralgia.

The healing process itself may also play a role. As injured tissues repair, scar tissue and thickened connective tissue can develop. Because the occipital nerves pass through multiple muscular and fascial layers, these changes may reduce the available space around the nerves and contribute to ongoing irritation or entrapment. In some individuals, the nervous system becomes more sensitive following injury. This process can cause normally harmless sensations to become painful and may contribute to scalp tenderness, increased nerve sensitivity, or symptoms that persist long after the initial injury has healed.

Occipital neuralgia is sometimes mistaken for migraines, tension headaches, or headaches that originate from the neck. Clues that suggest occipital neuralgia include pain that begins near the base of the skull, tenderness over the occipital nerves, scalp sensitivity, and sharp pain that radiates toward the top of the head. Because several conditions can produce similar symptoms, a thorough examination is important. If the examination suggests occipital neuralgia is present and the patient is a candidate for chiropractic care, treatment may include a multimodal approach using manual therapies, specific exercises, physiotherapy modalities, and patient education to help reduce mechanical stress on the occipital nerves. Chiropractors are also trained to recognize when co-management or referral to another healthcare provider may be appropriate.