Sinus pressure is typically understood as a feeling of fullness or discomfort located in the face, specifically around the eyes, cheeks, and forehead, caused by inflammation and congestion within the paranasal sinuses. While most people experience pain in these common areas, the sensation of pressure can sometimes be felt in a less expected location, such as the back of the head. This posterior head pain is usually not the direct result of pressure building up in the front-facing cavities. When sinus inflammation is linked to discomfort in the occipital region, it is often due to referred pain or the specific location of a deeply situated sinus cavity.
How Sinus Pressure Causes Referred Pain
The phenomenon of referred pain explains how an issue in one part of the body can be felt as pain in a different area. This sensory misinterpretation is rooted in the shared neural pathways that transmit signals from various regions to the brain. The trigeminal nerve (Cranial Nerve V) is the primary nerve responsible for sensation in the face, and it innervates all of the sinus cavities.
Inflammation or pressure originating in the sinuses can irritate the trigeminal nerve branches. This irritation travels along the nerve, and the brain may mistakenly interpret the signal as originating from another area that shares a nerve connection, such as the head or neck. The deep location of the sphenoid sinuses makes them the most likely source of sinus-related pain felt in the back of the head.
The sphenoid sinuses are situated deep within the center of the skull, behind the nose and eyes. When these cavities become inflamed due to infection or severe congestion, the resulting pressure can radiate backward. This deep-seated inflammation can manifest as intense pain or pressure felt at the top of the head, over the mastoid processes, or directly in the posterior region. Even when the pain is perceived at the back of the head, it is typically accompanied by classic signs of sinusitis, such as thick nasal discharge or facial congestion.
Other Causes of Pressure in the Back of the Head
Most instances of pressure or pain localized to the back of the head are not caused by sinus issues. The occipital and upper cervical regions are common sites for several other types of headaches and musculoskeletal conditions. Differentiating between a sinus issue and these other causes often depends on accompanying symptoms and the specific quality of the pain.
Tension headaches are the most common cause of head discomfort and frequently cause pressure in the back of the head. This pain is often described as a constant, non-throbbing ache or a sensation of a tight band squeezing the head. These headaches are typically mild to moderate in intensity and are associated with emotional stress, fatigue, or holding a single head position for extended periods, such as working at a computer.
Another frequent cause is cervicogenic headache, which originates from a problem in the neck or cervical spine. This type of pain is referred from structures like the neck joints, ligaments, or muscles and is felt in the head, often radiating from the back up to the front. Poor posture, neck muscle tension, or underlying arthritis in the upper spine can trigger this discomfort. The pain often worsens with specific neck movements or when the neck is held in an awkward position.
Migraine headaches, though often associated with throbbing pain on one side of the head, can also present atypically with pain localized to the posterior region. These headaches are usually more debilitating than tension headaches, frequently accompanied by nausea, vomiting, or heightened sensitivity to light and sound. Cluster headaches, while less common, can also cause intense, piercing pain sometimes felt in the back of the head, though they are classically felt behind one eye. Unlike these other causes, a true sinus issue will almost always involve symptoms like purulent nasal discharge, fever, or pain that worsens when bending forward.
Knowing When to See a Doctor
While most head pressure is benign, persistent or severe symptoms warrant professional medical evaluation to establish an accurate diagnosis. You should schedule a visit if the pressure or pain occurs more frequently than usual, becomes more severe, or fails to improve with over-the-counter pain relievers. Chronic pressure that interferes with daily activities, sleep, or work also indicates a need for medical consultation.
Specific “red flag” symptoms associated with head pain require immediate emergency medical attention. Any sudden onset of the “worst headache of your life,” often described as a “thunderclap” headache, needs immediate evaluation as it can signal a serious condition like a hemorrhage.
Other concerning symptoms include headache accompanied by a high fever, a stiff neck, or changes in mental state such as confusion or difficulty speaking. Neurological deficits like sudden numbness, weakness, or trouble seeing or walking alongside a headache also require emergency care. These signs suggest a potentially life-threatening condition, such as meningitis, encephalitis, or a stroke.