The sensation of feeling or hearing a rhythmic pulse localized to the back of your head or neck can be a startling experience. This internal thrumming noise is often synchronized precisely with your heart rate, creating a unique awareness of your own circulation. While this phenomenon can be confusing and sometimes unsettling, it frequently has identifiable and manageable explanations rooted in changes to your body’s blood flow dynamics. Understanding the mechanism behind this pulsing sensation is the first step toward determining its origin.
Understanding Pulsatile Tinnitus and Location
The technical term for hearing your pulse within your head is pulsatile tinnitus. This sensation occurs when the flow of blood through vessels near the inner ear or skull is amplified, creating an audible sound that is not external. Normally, surrounding tissue muffles the sound of blood moving through arteries and veins, but a change in flow velocity or proximity can make it noticeable.
The reason this pulse is often perceived in the back of the head, or the occipital and mastoid regions, relates directly to the underlying anatomy. Large blood vessels, including the internal jugular veins and the vertebral arteries, travel through the neck and close to the base of the skull. If blood flow within these vessels becomes turbulent or positioned unusually close to the inner ear structures, the resulting sound wave transmits through the bone, leading to the perception of a thumping or whooshing noise.
Common Systemic Causes
The awareness of a pulse in the head is often due to temporary, systemic changes that increase the overall volume or speed of blood flow throughout the body. These high-output states make the normal sounds of circulation louder and more noticeable. Conditions like severe anemia or hyperthyroidism can cause the heart to pump blood faster and with greater force to compensate for changes in blood chemistry or metabolism.
Temporary increases in blood pressure (hypertension) force blood through vessels more forcefully, creating a more pronounced sound near the auditory system. Intense physical exertion or moments of significant stress and anxiety trigger the release of hormones that temporarily increase heart rate and blood flow velocity. This higher velocity causes the blood flow to become less smooth, generating the turbulent noise you perceive as a pulse. Certain medications, including some nonsteroidal anti-inflammatory drugs (NSAIDs) or excessive intake of stimulants like caffeine, can also raise blood pressure and contribute to this amplified awareness.
Structural and Vascular Conditions
When the pulsatile sensation is persistent, it may point toward a physical change in the structure of the blood vessels themselves, leading to turbulent flow.
Atherosclerosis
A common structural issue is atherosclerosis, the narrowing of arteries due to plaque buildup. When major vessels like the carotid artery in the neck narrow, blood must rush through the restricted segment, causing a noisy, irregular flow that is easily perceived.
Venous System Issues
Another common cause is an issue within the venous system, such as dural venous sinus stenosis. This involves the narrowing of the large veins that drain blood from the brain. This narrowing increases the pressure and velocity of blood flow, often leading to a whooshing sound synchronized with the pulse. This condition is frequently associated with idiopathic intracranial hypertension (IIH), where increased pressure within the skull fluid compresses these draining veins. Less common but significant causes include vascular malformations, which are tangles of arteries and veins that create abnormal connections and highly turbulent circulation.
When to Consult a Medical Professional
While many causes are temporary or benign, the presence of pulsatile tinnitus should always prompt a professional medical evaluation to rule out more serious underlying conditions. Seek prompt attention if the sensation is sudden in onset or rapidly worsens.
Specific symptoms that accompany the pulsing sensation are considered red flags and require immediate investigation:
- Sudden changes in vision.
- Persistent dizziness.
- New-onset hearing loss.
- Severe, uncharacteristic headaches.
A doctor will typically perform an initial examination, including checking blood pressure and listening to the blood flow in your neck and head. They may then recommend specialized imaging, such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA), to visualize the blood vessels in your head and neck and identify the structural source of the turbulent flow.