Understanding headaches at the back of the head, temples and jaw

‘Occipital’ initially means only ‘at the back of the head’. Occipital neuralgia, however, is a specific pain pattern in the area supplied by the occipital nerves. Typical symptoms may include brief, intense, shooting or stabbing attacks. The short muscles just below the back of the skull can also be tender or tense at the same time. Sometimes the scalp feels different or even a light touch is painful. Longer-lasting pressure at the back of the head therefore does not necessarily come from these nerves. Pain may also radiate into this area from the upper neck joints or muscles, for example. The distinction matters for the next step: a treatment considered for a particular nerve disorder is not automatically suitable for every pain at the back of the head.

Some of the chewing muscles lie in the temple area. Painful disorders of these muscles or the jaw joints can therefore cause headaches at the temples. The terms used are craniomandibular dysfunction, or CMD, and temporomandibular disorder. If your familiar pain changes with chewing, mouth movements or clenching your teeth, this is useful to mention. An examination is needed here too. Painless clicking in a jaw joint alone does not mean there is a problem requiring treatment. Temple pain may also have another cause. If there are signs of jaw involvement, a dental assessment is helpful, alongside an orthopaedic examination where appropriate. Please therefore tell us about any existing diagnosis or a splint that has already been fitted.

Migraine and tension-type headache are distinct headache disorders. ‘Tension-type’ does not mean that a tense muscle is necessarily the cause. Nausea, sensitivity to light or sound, and the duration and frequency of symptoms help with assessment. Several types of pain may also coexist. An orthopaedic examination therefore answers a particular question: is there a treatable link to the musculoskeletal system? It does not replace every other form of headache assessment. If the symptoms require assessment by a GP, neurologist, ophthalmologist or dentist, that next step belongs in the plan. Bring any existing results so that questions already clarified can be taken into account.

Tell us when the pain first occurred, where it starts and whether its character has changed. Does it come in separate attacks, or is it present almost every day? Can you read, eat or go for a walk while it is happening? These differences are often more informative than simply saying the pain is ‘severe’. Depending on the clinical question, we examine movement, muscles and your response to suitable movements. We want to know whether your familiar pain can be reproduced. We discuss existing images and findings in context. Recurring symptoms alone do not automatically require new images. Whether additional investigations are useful depends on changes, examination findings and what difference the results would make to treatment.

We first discuss which parts of your symptoms the findings can explain and which goal matters to you. Enjoying a meal again, turning your head more easily or having to interrupt activities because of pain less often: goals like these also make treatment progress easier to assess. The options depend on the diagnosis. For tension-type headache, treatment may include adapted movement, physiotherapy techniques and relaxation methods, among other approaches. For jaw symptoms, gentle measures and guided exercises to do yourself are often the initial focus; any necessary dental treatment is assessed by the dental team. The location of pain alone cannot determine which options suit you. We want to agree a clear next step with you. Longstanding pain does not rule out improvement, but how much improvement is possible and how long it will take cannot be predicted. If a measure does not help or new symptoms develop, the previous assessment must be reviewed.