Occipital Headaches: Description, Symptoms, and Treatment

Occipital headaches most commonly occur at the back of the head, scalp, or the base of the skull. These types of headaches often involve inflammation or injury of the occipital nerves, which run from the cervical spine (neck) to the rear portion of the scalp. The underlying neurological cause of occipital headaches is often referred to as occipital neuralgia. 

If this is your first time hearing the term occipital headaches, you are not alone. Many of the symptoms of occipital headaches overlap with those of migraines, leaving countless numbers of veterans who suffer from occipital headaches undiagnosed and improperly treated. That is why it is extremely important that you consult with a physician or neurologist if you are experiencing any of the symptoms listed below:

– Aching, burning and throbbing pain that typically starts at the base of the head and goes to the scalp

– Pain on one or both sides of the head

– Pain behind the eye

– Sensitivity to light

– Tender scalp

– Pain when you move your neck

While some of the symptoms for occipital headaches may seem similar to those of general headaches or migraines, the diagnosis and treatment of occipital headaches is quite different from other headache conditions. Physicians commonly diagnose occipital headaches by injecting anesthetics or steroids at the base of the skull to shut down the occipital nerve’s pain response. If the headache stops, the occipital nerve can be identified as the cause of the headaches. This procedure can also be used as an effective treatment for occipital headaches.

Getting Service Connected for Occipital Headaches: What Evidence is Needed

The VA’s disability evaluation system uses a rating schedule for each condition to determine the severity of symptoms that must be present for a veteran to receive a particular level of compensation. Because no specific rating schedule exists for occipital headaches, they are evaluated based on the rating schedule for migraines (see next section), which are “closely analogous” under 38 CFR 4.20.

Similar to other headache conditions, you are eligible for service connection for occipital headaches if your condition was diagnosed in service, within twelve months of discharge, or as a secondary condition to another service-connected impairment. Medical treatment records from your service, VA medical treatment records, and records from other doctor and clinic visits can help you establish service connection for occipital headaches.

Many veterans with occipital headaches find that their headaches are so severe that daily activities become nearly impossible, including the tasks often associated with working even a sedentary job. As evidenced by the rating schedule below, the highest schedular disability rating available for occipital headaches is 50 percent. To get a 50 percent rating, you must experience “completely prostrating and prolonged attacks” (headaches so bad that you must lie down) several times each month. However, given the opinions of our consulting vocational experts, our firm fully believes and consistently argues to the VA that anyone who is required to lie down for long periods several times a month cannot meet the demands of any substantially gainful occupation (SGO) because any SGO requires that a worker maintain regular attendance. The VA typically accepts this view and will grant a veteran with severe service-connected headaches a total disability rating based on individual unemployability (TDIU rating), which pays 100 percent compensation on a monthly basis.

How the VA Rates Occipital Headaches

Like all headache conditions, occipital headaches are evaluated using the rating schedule for migraine headaches under Diagnostic Code 8100, with a maximum schedular rating of 50 percent. 

50 Percent:

With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability

30 Percent:

With characteristic prostrating attacks occurring on an average once a month over last several months

10 Percent:

With characteristic prostrating attacks averaging one in 2 months over last several months

0 Percent (Noncompensible):

With less frequent attacks

Helpful definitions

What does the VA mean by the terms “prostrating,” “severe economic inadaptability,” and “very frequent” or “less frequent”? The VA’s Manual M21-1MR defines these terms as follows: 

  • Prostrating – means “causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities.”
  • Completely Prostrating – means “extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities.”
  • Severe economic inadaptability – “denotes a degree of substantial work impairment.  It does not mean the individual is incapable of any substantially gainful employment.  Evidence of work impairment includes, but is not necessarily limited to, the use of sick leave or unpaid absence.” (Italics Added)
  • Less Frequent – means “duration of characteristic prostrating attacks, on average, are more than two months apart over the last several months.”
  • More Frequent – means “duration of characteristic prostrating attacks, on average, are less than one month apart over the last several months.” 

Making Your Claim as Strong As Possible

In simplest terms, you will need to do everything possible to document the frequency and severity of your occipital headache attacks. By far the best evidence is medical evidence (1) diagnosing you with occipital headache attacks that began in service, were caused by an in-service incident, illness, or exposure, or were caused by another service-connected condition and (2) specifying that the attacks are very frequent, prostrating and prolonged headaches. Such evidence usually comes from a neurologist or primary care physician whom you are seeing who has knowledge of your condition. Even if you do not have access to treatment with a neurologist or a doctor that has experience treating occipital headaches, you still need to report your symptoms to your doctor so that there is medical evidence documenting your symptoms as well as the severity and frequency of the headache attacks you experience. If you have ever had to receive emergency treatment for your headaches, make sure to obtain the medical records and discharge summaries of those incidents. This medical evidence is very important because the VA will almost certainly refer you to a Compensation & Pension (C&P) examination with one of its examining doctors, who are often underpaid, overworked, and incentivized to spend as little time reviewing your records, interviewing you, and completing the Migraine Headaches Disability Benefits Questionnaire (DBQ) as possible. Having favorable medical evidence for your claim already in your file stacks the deck in your favor as it is more likely the examining doctor will adopt the findings of your treating doctor regarding your diagnosis and the severity and frequency of your headaches. Additionally, in the event that the C&P examiner misstates the frequency or severity of your occipital headache attacks, there will already be favorable medical evidence in your file showing the true frequency and severity of the attacks, which can help combat unfavorable C&P exam findings.

In addition to having favorable medical evidence, it will also benefit you to keep a detailed log of your occipital headache attacks, documenting the occurrence of each headache as well as its severity, length, and associated symptoms. A headache log can be kept via a number of formats, such as an excel sheet, written on a calendar, or as a continuous written log on your smartphone’s note application. In our experience, keeping a detailed headache log is always beneficial for your claim because upon VA review it lends an extra layer of credibility on top of any sworn statements from yourself, friends, or family members.

Lastly, veterans need to be honest and forthright about their symptoms when speaking with the VA’s C&P examining physician. Even if you feel rushed by the doctor or have difficulty opening up about the severity of your occipital headaches with people with whom you are unfamiliar, it is important that you quickly and accurately describe the frequency and severity of your headache attacks in a way that the doctor can understand even if he or she is half listening or filling out the DBQ report while you are talking. Though you should never exaggerate your symptoms, you should always describe your pain as accurately as possible so you can receive the most appropriate rating for your occipital headaches.

Contact The Veterans Law Office About Your Occipital Headaches Claim

If you are a veteran and have not been properly compensated for your occipital headaches that you believe are a result of your service in the military, please contact our office for a free consultation. Our veterans disability attorneys have extensive experience representing veterans who suffer from occipital headaches in both claims for service connection and claims for increased ratings. If you are a veteran experiencing occipital headaches, please call the number at the top of this page or fill out our free case evaluation form.