Occipital neuralgia (ON) is a condition characterized by neuropathic pain in the distribution of the occipital nerves, which include the greater occipital nerve, the lesser occipital nerve, and the third occipital nerve, or a combination of the three. The pain is typically paroxysmal, sharp, and excruciating in the posterior head region, lasting from seconds to minutes and may radiate to the anterior region of the head and face. ON can result from both structural and non-structural causes, but it is most commonly associated with the compression or irritation of one or more occipital nerves, with the greater occipital nerve (GON) responsible for the majority of cases. Contributing factors, such as muscle hypertrophy or spasms, may exacerbate nerve compression. Other causes of ON include trauma, spinal cord tumors, Chiari malformation, arteriovenous malformation, demyelinating lesions, and neurosyphilis. Treatment options include conservative measures, complementary therapies, and minimally invasive approaches such as nerve blocks, pulsed radio frequency, and occipital nerve stimulation. In refractory cases, surgical interventions may be necessary.