February 12, 2026 | Nerve Pain, Occipital Neuralgia
4 minute read
Over the past week alone, several patients have asked essentially the same question, “Are my tight neck muscles irritating the nerves, or are irritated nerves causing my muscles to tighten?” It’s a fair question, and frustratingly, the answer is often: both. In many cases, it’s less a straight line of cause and effect and more a feedback loop—similar to the classic “chicken or the egg” problem. Once the cycle begins, it can be very difficult to determine what started it. Still, understanding how these two systems interact can help clarify why symptoms persist—and why certain treatments work better than others.
How muscles and nerves influence each other:
The occipital nerves travel through a crowded environment-layers of fascia, muscle, and blood vessels in the back of the head and upper neck. They are particularly vulnerable to mechanical irritation. Two things can happen:
- Muscles irritate nerves
Tight, inflamed, or chronically contracted muscles can physically compress or rub against these nerves. That pressure may trigger occipital neuralgia symptoms.
- Nerves irritate muscles
Conversely, an irritated nerve sends pain signals to the surrounding tissues. In response, the body reflexively “guards” the area. Muscles tighten to protect it.
That tightening leads to stiffness and spasm. Which, unfortunately… can compress the nerve even more.
The pain–spasm cycle
Once this interaction starts, it often becomes self-perpetuating: Nerve irritation → pain → muscle contraction → more compression → more pain → more contraction. Over time, this loop reinforces itself. And because most patients have been dealing with symptoms for years, it’s often impossible to pinpoint which factor came first. But clinically, that question matters less than people think.
Why muscle-focused treatments don’t always solve the problem
Many patients understandably focus on the muscles first.
They try:
- Physical therapy
- Massage
- Stretching programs
- Active release techniques (art)
- Muscle relaxants
- Other medications
These approaches can help, and they’re reasonable first steps. But when they repeatedly fail to provide lasting relief, it suggests something important: The muscle tightness may not be the primary driver-it may be secondary. If the nerve remains irritated, the muscles often return to guarding and spasm, no matter how much you stretch or relax them.
What we sometimes see with nerve blocks
This is where diagnostic nerve blocks can be very revealing. When we temporarily numb the occipital nerve with a long-acting anesthetic, two things often happen:
- The pain improves quickly
- The muscles relax—sometimes dramatically
Patients frequently notice they can move their neck more freely within minutes. Movements that typically trigger pain suddenly feel normal. The stiffness they’ve lived with for years softens. That change isn’t coincidental. It suggests that calming the nerve allows the muscles to “stand down.” In other words, the muscle spasm may have been a protective response all along.
What this tells us
If temporarily quieting the nerve leads to:
- Less pain
- Less spasm
- Better movement
…then addressing the nerve more definitively may allow the muscles to recover as well. In some cases, treating the nerve doesn’t just help the nerve-it helps the entire mechanical system of the neck and upper back. Even distant muscles can function better once they’re no longer compensating for chronic guarding.
The takeaway
It’s natural to want a clear answer about what started the problem. But with occipital neuralgia, that question often isn’t the most useful one. Whether the muscle or the nerve came first, the two quickly become intertwined. The more productive focus is this: What intervention breaks the cycle? For many patients, addressing the nerve component directly can be the turning point. Because sometimes the fastest way to relax a tight muscle isn’t stretching it-it’s calming the irritated nerve that’s forcing it to tighten in the first place.
