Pressure or pain in the back of the head and upper neck is a common symptom that often leads people to wonder if sinuses are located there. This discomfort can feel precisely like the pressure experienced during a sinus infection. However, there are no paranasal sinuses located in the back of the neck or the lower part of the skull. This sensation of pain results from complex nerve pathways and other underlying conditions, not sinus cavities.
The True Location and Purpose of Sinuses
The paranasal sinuses are air-filled cavities located entirely within the bones of the face and skull. These spaces are situated near and connected to the nasal cavity, existing as four distinct pairs. The maxillary sinuses are positioned beneath the eyes in the cheekbones, and the frontal sinuses are located just above the eyes in the forehead bone.
Deeper within the facial structure are the ethmoid and sphenoid sinuses. The ethmoid sinuses consist of small air cells located between the eyes and the nose. The sphenoid sinuses are the deepest, situated in the sphenoid bone behind the nose and eyes. All sinus structures are contained well above the neck.
The functions of these hollow spaces are varied. They help reduce the overall weight of the skull and play a role in moisturizing and warming inhaled air before it reaches the lungs. They also contribute to the resonance of the voice and act as a protective zone against facial trauma.
Why Sinus Issues Cause Pain in Unexpected Places
When the paranasal sinuses become inflamed or blocked, the resulting pressure can activate referred pain. This occurs because the brain misinterprets the origin of the pain signal due to shared sensory nerve pathways. The sinuses and much of the face are heavily innervated by the Trigeminal nerve (Cranial Nerve V).
The Trigeminal nerve is a complex network that transmits sensations from the face, forehead, and jaw to the brain. When pressure builds up in the sinuses, pain signals travel along these pathways. The brain struggles to pinpoint the exact source, occasionally projecting the feeling of pressure to nearby areas.
The Trigeminal nerve manages facial sensation but shares connections with the upper cervical nerves of the neck in the trigeminocervical complex. This neurological overlap is the mechanism by which pain signals originating in the face can be perceived as aches in the back of the head or upper neck.
Non-Sinus Causes of Neck and Head Pressure
The most common reasons for experiencing pressure or pain in the back of the head and upper neck relate to muscle tension, nerve irritation, or issues with the cervical spine. These conditions are frequently mistaken for sinus problems because they produce a dull, persistent ache or a feeling of deep pressure.
Tension Headache
One widespread cause is a tension headache, which involves the muscles of the neck and scalp, particularly the suboccipital muscles at the base of the skull. The pain is often described as a tight band or vice-like pressure around the head that can radiate down the neck. This condition is triggered by physical or emotional stress, poor posture, or fatigue, leading to sustained muscle contraction.
Occipital Neuralgia
Another distinct cause is occipital neuralgia, involving irritation or inflammation of the occipital nerves that run from the upper neck through the scalp. This condition produces a characteristic sharp, shooting, or electric-shock-like pain. The pain starts at the base of the skull and spreads to the back of the head, sometimes behind the eyes. The nerves can become compressed or entrapped by tight neck muscles or trauma.
Cervicogenic Headache
Pain can also originate directly from the neck structures, known as a cervicogenic headache. This type of headache is secondary, caused by a disorder or dysfunction in the cervical spine. Examples include problems with the joints, discs, or soft tissues in the upper neck. The pain typically starts in the neck or the back of the head and then radiates to the front, often remaining on one side.
Poor posture, especially the forward head posture common during prolonged screen use, puts excessive strain on the neck and upper back muscles. This chronic strain can lead to tension headaches and contribute to nerve entrapment. Identifying the true source of pain, whether muscular, nerve-based, or structural, allows for a targeted treatment plan.