Occipital Headache Causes and Diagnostic Considerations

Secondary Causes

The American College of Radiology recommends evaluating Chiari I malformation, characterized by cerebellar tonsillar herniation through foramen magnum, with headache worsened by Valsalva maneuver in children over 3 years 1
Arterial dissection requires urgent CTA of head and neck if strongly suspected, according to the American College of Radiology 1
Venous sinus thrombosis should be evaluated with MRV or CTV if venous outflow obstruction is suspected, as recommended by the American College of Radiology 1
Subarachnoid hemorrhage, especially with arterial aneurysm, is a potential cause of occipital headache, as noted by the American College of Radiology 1
Meningeal infiltration or enhancement should be evaluated with MRI with contrast, as suggested by the American College of Radiology 1

In children, isolated occipital and cervical pain are not characteristic of any primary headache group and warrant diagnostic caution, according to the American College of Radiology 1
Meningeal enhancement on MRI after lumbar puncture should not be confused with pathology, as noted by the American College of Radiology 1

MRI of the brain with and without contrast is preferred for evaluating secondary causes, including Chiari malformation, tumors, and meningeal pathology, as recommended by the American College of Radiology 1
Sagittal T2-weighted sequence of the craniocervical junction is suggested for suspected Chiari I deformity, according to the American College of Radiology 1
CTA or MRA is recommended for suspected arterial dissection, as noted by the American College of Radiology 1
MRV is preferred over CTV in children for venous sinus thrombosis evaluation, as suggested by the American College of Radiology 1