What causes pain on both sides of the neck at the back of the head?

Pain on both sides of the back of the head and neck may result from tension-type headache, hypertension, cerebral infarction, or other causes.

1. Tension-Type Pain

This pain may be due to tension-type headache—for example, resulting from prolonged periods of mental stress at work, excessive physical fatigue, or chronic sleep deprivation caused by long-term late-night activity. Patients may simultaneously experience a sensation of pressure or dull aching.

2. Hypertension

The pain may also stem from hypertension. Persistent elevation of blood pressure or significant blood pressure fluctuations can cause abnormal dilation of intracranial blood vessels, leading to vascular pain. This pain is often pulsatile or paroxysmal and may be accompanied by a feeling of pressure or tightness. In severe cases, patients may experience nausea, vomiting, and other symptoms.

3. Cerebral Infarction

If cerebral infarction occurs—particularly in association with internal carotid artery dissection or vertebral artery dissection—pain on both sides of the back of the head and neck may manifest during the acute phase. Additional symptoms may include speech disturbances, neck stiffness, dizziness, or motor deficits.