- Seek emergency care for severe headache with chest pain, shortness of breath, vision changes, numbness, weakness, or difficulty speaking.
- Pain on top of the skull with nausea, vomiting, or sensitivity to light or sound may be a sign of migraine.
- Frequent, severe, or worsening pain should be evaluated by a healthcare provider, especially when other symptoms are present.
Pain on top of the skull is not very common and is usually linked to muscle tension or fatigue, especially from poor posture or stress. It can also occur with tension headaches or after not getting enough sleep.
In some cases, pain on top of the skull may be accompanied by symptoms like nausea, vomiting, or vision changes. When this happens, it may be related to conditions such as migraine, occipital neuralgia, or even a sudden increase in blood pressure.
Treatment depends on the cause and may include rest, stress management, medication, or medical intervention for more serious conditions. Pain that is frequent or severe, especially when accompanied by other symptoms, should be evaluated by a healthcare provider.
Pain on top of the skull may be caused by:
1. Tension headaches
Tension headaches usually occur due to muscle contractions and stiffness in the neck and shoulders from stress, anxiety, depression, or poor posture.
According to the National Headache Foundation, tension-type headache is characterized by a pressing or tightening sensation (not throbbing) that is typically felt on both sides of the head, with mild to moderate pain intensity. The pain is steady rather than pulsating and can last from 30 minutes to several hours or days.
What to do: To relieve tension headaches, try relaxation techniques and gently massage the scalp, neck, and shoulder muscles. A healthcare provider may recommend over-the-counter anti-inflammatory medications or analgesics to reduce discomfort.
2. Occipital neuralgia
Occipital neuralgia is characterized by irritation or damage to the occipital nerves located at the base of the skull. This condition can occur due systemic diseases, trauma, or tumors.
Occipital neuralgia causes intense headaches that are often constant and typically worsen with neck movement. Although the pain primarily affects the back of the head, it can radiate forward to the top and sides of the head.
What to do: Treatment for occipital neuralgia depends on the severity of symptoms and may be managed by a primary care provider, neurologist, or pain specialist. Options may include rest, physical therapy, medications, nerve blocks, and, in rare cases, surgery.
3. Migraine
Migraines are intense headaches that may occur repeatedly and are often triggered by stress, hormonal changes, lack of sleep, or certain foods and drinks, including caffeine.
Although migraines are usually felt on one side of the head, pain can also occur on top of the skull. According to the World Health Organization (WHO), migraine attacks usually last 4 to 72 hours and are often accompanied by nausea, vomiting, and sensitivity to light or sound.
Read more about how to recognize migraine symptoms when they occur.
What to do: Treatment may include over-the-counter pain relievers, anti-inflammatory medications, or prescription drugs such as triptans. A healthcare provider can recommend the most appropriate treatment based on symptoms and frequency.
4. Fatigue
Lack of sleep or extreme fatigue can trigger headaches that may be felt on top of the head or throughout the skull. When you sleep fewer hours than your body needs, it can lead to tension-type headaches or make existing headaches worse.
Sleep deprivation also causes fatigue, irritability, difficulty concentrating, and reduced productivity the following day. See what can cause extreme fatigue and what you can do to prevent it.
What to do: In these cases, it is important to rest and relax. As you recover your energy, the pain on top of your skull will tend to improve.
Consider helpful techniques such as massage, regular exercise, yoga, and most importantly, getting adequate sleep each night. You can also try incorporating foods that give you more energy into your diet.
5. Hypertension
Hypertension (high blood pressure) usually does not cause noticeable symptoms, but a sudden increase to levels above 180/120 mmHg, known as a hypertensive crisis, can lead to severe headaches that may be felt at the back or top of the head.
According to the American Heart Association, blood pressure readings of 180/120 mmHg or higher with symptoms such as chest pain, shortness of breath, vision changes, numbness, weakness, or difficulty speaking require emergency care. A hypertensive crisis may also cause headache, blurry vision, dizziness, or confusion.
Read more about the symptoms of high blood pressure and when to see a doctor.
What to do: A hypertensive crisis is a medical emergency that requires immediate care. If symptoms occur, it is important to go to the emergency room, as prompt treatment can help prevent complications like internal bleeding or heart failure.
Treatment in the hospital may include intravenous (IV) medications to quickly lower blood pressure. After stabilization, a doctor may recommend lifestyle changes, such as reducing salt intake and exercising regularly, to help manage blood pressure long term.