Neck Pain and Pain Behind the Eye: How They Connect

Pain behind one eye can start in the neck. Nerves from the top of the neck feed into the same pain relay area as the nerve that serves the face and forehead, so the brain can read a neck problem as pain behind the eye. Trigger points in the small muscles at the base of the skull and in the long muscle at the side of the neck are common sources, once the eye and other causes have been checked.

What it feels like

Most people describe a dull pressure behind one eye, sometimes spreading to the temple or forehead, often on the same side as a stiff neck. It tends to build after holding your head still for a long time or sleeping awkwardly. Pressing at the base of the skull may make the eye ache stronger.

Why the neck can hurt behind the eye

Feeling from the face, forehead and front of the head travels through the trigeminal nerve. Feeling from the back of the head and upper neck travels through the first few nerves of the neck. These two sets of nerves feed into the same pain relay area. The international headache classification describes this convergence between upper neck and trigeminal pain signals as well understood.

The result is a kind of crossed wire. Signals from a neck joint or muscle arrive where signals from the forehead and eye area do, and the brain can place the pain in front. This is referred pain: real pain, felt away from where it starts.

The muscles most often involved

• Suboccipitals, small muscles just under the base of the skull. Trigger points here often cause aching at the back of the head that can travel forward.
• Sternocleidomastoid, the long muscle from behind the ear to the collarbone and breastbone. It commonly refers pain to the face and eye.
• Upper trapezius, from the base of the skull to the top of the shoulder. It can also refer pain toward the face and eye.

Irritated occipital nerves, which pass through these muscles, can add shooting or burning scalp pain.

Neck, migraine or something else?

The neck is only one possible cause. Headache specialists list a few clues that point toward the neck: pain that stays on the same side, pain brought on by pressing on neck muscles or by moving the head, and pain that travels from the back of the head toward the front. They also note these clues are not unique to neck-related headache.

Migraine is often one-sided too. Cluster headache causes pain behind or around one eye, often with a red, teary eye on that side. Angle-closure glaucoma causes intense eye pain with a red eye, blurry vision and nausea, and the National Eye Institute calls it a medical emergency.

That is why new eye pain should be evaluated by your primary care doctor, neurologist or eye doctor before I treat the neck. Some people have more than one cause at once.

How I check it

The first visit runs 60 to 75 minutes. I review notes from your physician or eye doctor, test which neck movements bring on the eye pain, and assess the suboccipitals, trapezius, sternocleidomastoid, occipital nerves and jaw muscles by hand. When pressing a spot in the neck brings on your familiar ache behind the eye, that is a useful clue.

How it is treated

Dry needling releases trigger points in the neck and jaw muscles that refer pain to the head and face. Alongside dry needling, I use neuro-functional acupuncture, built on neuroscience and evidence-based practice. Unlike regular electroacupuncture, the needles and gentle electrical stimulation are mapped to the specific nerves involved, such as the occipital and cervical nerves. It works in three ways. It neurorehabilitates, helping irritated tissues and nerve receptors recover. It neuromodulates, shifting the body's own pain-relieving chemistry. It neuroregulates, calming the nerve signals and circuits that keep nerve pain going. The head pain page covers the full plan. Most patients are seen weekly or every other week during active care, and results vary from person to person.

If you are not sure what is causing your pain, try the My Symptoms tool.