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Face and Jaw Surgery

Pain in lower back of head.

12/11/2006

Question:

I am not sure if I am in the right place, but I need an answer. Earlier this evening I was playing with my cats. They were making me laugh. The harder I laughed the more the back of my head hurt. And it hurt BAD.. I had to stop myself from laughing because it felt like the back of my head was going to literally explode. After I settled down and stopped laughing, the pain went away.. what on earth could cause such a thing? The best way I can explain the location of the pain is to put my hands over my ears and touch finger tip to finger tip, probably about where the spinal cord ends. The pain is very deep.

Answer:

Pain in the back of the head is often referred to as a cervicogenic (meaning: from the neck) headache because it often originates from an irritation in the upper cervical (neck) spine. This is because the nerves that supply the back of the head originate in the upper cervical spine. It is seen most commonly in patients with whiplash injury and in patients with marked arthritis of the upper cervical spine. Usually this kind of pain is worse with prolonged sitting in a stooped posture as when working on a keyboard for long hours.  

The fact that you have had the pain with laughing is unusual but can be explained. When we laugh, we activate a lot of our muscles in the face, and we may extend our neck depending on the position. Neck extension sometimes may cause worsening of the pain in patients with cervicogenic headache.

On the other hand, there are patients who experience a lot of pain in their faces when they laugh. They usually have a condition called trigeminal neuralgia (also known as tic douleureux) that is due to irritation of the fifth cranial nerve (also known as the trigeminal nerve). Interestingly, the trigeminal nerve fibers in their path from the face to the brain stem, "dip" into the upper cervical spine, in the same area where the nerve fibers that supply the back of the head travel. These may be the reason why you had pain when you were laughing. Fortunately, it only happened once and you may not need to do anything about it at this point in time. However, if it recurs, you may need to see a neurologist for diagnostic workup.

Best of luck!

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Response by:

Salim M Hayek, MD, PhD Salim M Hayek, MD, PhD
Associate Professor of Anesthesiology & Perioperative Medicine
School of Medicine
Case Western Reserve University