Tension-type headache
Triggered by long desk hours, stress, dehydration, or eye strain. Presents as a tight band or pressure around the scalp and often improves with rest, hydration, and stretching.
Headache & Spine Clinic · Hyderabad
Pain on Top of the Head — Causes & Next Steps
Vertex headaches can stem from posture, migraines, or nerve compression. Discover the most common causes, urgent warning signs, and when to escalate to a neurosurgical evaluation.
Common causes of vertex head pain
Migraine
Moderate to severe throbbing pain that may migrate to the top of the head. Often accompanied by nausea, light sensitivity, or aura. Acute medication and prophylaxis reduce attack frequency.
Posture-related strain (“tech neck”)
Forward head posture stresses upper cervical muscles and joints. Common among IT professionals and students. Ergonomics and targeted strengthening deliver relief.
Cervicogenic headache
Pain that starts in the neck and radiates to the scalp due to facet or disc pathology. Worsens with neck movement; often linked to cervical radiculopathy or stenosis.
Occipital neuralgia
Irritation of the occipital nerves causes stabbing or burning pain radiating to the crown. May follow muscle spasm, nerve entrapment, or whiplash injuries. Nerve blocks or minimally invasive release can provide long-term relief.
Red flags — seek urgent medical care
- • Sudden “thunderclap” headache or severe pain with vomiting
- • Headache with fever, neck stiffness, or rash
- • Neurological symptoms: weakness, vision loss, speech changes
- • Pain after head injury with drowsiness or confusion
- • Progressive headaches in adults over 50 with systemic symptoms
Visit the nearest emergency department immediately if any red flag is present. Early intervention can rule out life-threatening causes.
Diagnostic approach at Yashoda Hospital, Malakpet
- Detailed history including triggers, occupation, sleep, and stress.
- Neurological and cervical spine examination for posture and nerve function.
- Imaging: MRI brain/CT head for red flags; MRI cervical spine when nerve compression is suspected.
- Blood pressure, blood tests, or eye evaluation as indicated.
- Multidisciplinary review with physiotherapy, pain medicine, or neurology.
Treatment pathways
Lifestyle optimisation
Ergonomic assessments, posture correction, hydration goals, and sleep hygiene reduce muscle tension. We provide stretching sequences for desk work.
Physiotherapy & manual therapy
Cervical stabilisation, scapular strengthening, and manual release address cervicogenic headaches and posture-driven pain.
Medication management
Tailored plans for migraine, tension-type, or neuralgia include acute and preventive therapies. We monitor side effects closely.
Nerve blocks & interventional pain care
Occipital nerve blocks, radiofrequency ablation, or trigger point injections relieve refractory cases and help confirm diagnosis.
Minimally invasive spine surgery
When MRI shows nerve compression, endoscopic foraminotomy or decompression offers motion-preserving relief. Surgery is a last resort after conservative measures.
Living well during recovery
- • Keep a headache diary noting triggers, food, sleep, and stress.
- • Take microbreaks every 45 minutes to stretch and reset posture.
- • Use a cervical-support pillow and avoid stomach sleeping.
- • Stay hydrated and maintain balanced meals to avoid hypoglycaemia.
- • Engage in core and neck-strengthening exercises under guidance.
Frequently Asked Questions
Is pain on the top of my head always serious?
Most vertex headaches relate to tension, migraine, or posture strain. However, severe or persistent pain—especially with neurological symptoms—should be reviewed urgently.
Can cervical spine issues cause pain on top of the head?
Yes. Cervicogenic headaches and cervical radiculopathy often refer pain to the vertex. Imaging and clinical examination help confirm the source.
Do I need an MRI immediately?
Not always. MRI is recommended if headaches persist despite care, present with red flags, or occur alongside neurological deficits. We guide the timing after assessment.
What home strategies can help?
Ergonomic adjustments, posture exercises, hydration, sleep hygiene, and stress management reduce muscle tension. Persistent pain still warrants medical review.
Are nerve blocks safe?
Occipital nerve blocks are minimally invasive and effective when performed by experienced specialists. They help both diagnose and treat occipital neuralgia.
Dr. Sayuj Krishnan, Neurosurgeon
Room 317, OPD Block, Yashoda Hospital, Malakpet, Hyderabad, Telangana 500036
Phone: +91 9778280044 · Email: neurospinehyd@drsayuj.com
Authored by: Dr. Sayuj Krishnan S, Neurosurgeon
Reviewed by: Dr. Sayuj Krishnan S, Board Certified Neurosurgeon
Last reviewed: 14 February 2025
Disclaimer: This content is for informational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment.