What happens to the pain at the top of the back of the head? There are several causes of pain at the top of the back of the head: the first one is hypertension, which is one of the most common causes of headaches, and some patients can experience pain at the back of the head. The second cause is cerebrovascular disease, especially aneurysm and arteriovenous malformation, which can cause pain at the top of the back of the head. The third cause is encephalitis and intracranial tumors, which are organic brain diseases that can also cause pain in the top of the back of the head. The fourth cause is cervicogenic headache. The so-called cervicogenic headache is caused by cervical spine diseases that lead to cervical spine osteophytes and muscle stiffness, which can cause pain at the top of the back of the head by compressing the nerves innervating the back of the occipital area.