Pins and needles kind of pain is the characteristic of neuropathic headache, the top of the head belongs to the innervation range of the occipital nerve, so it should be occipital neuralgia. Most cases of occipital neuralgia are caused by cervical spondylosis, where the neck muscles are tense and toned, compressing the occipital nerve. In a few cases, it is caused by viral infections that invade the occipital nerve, especially herpes zoster virus infection, which can be found in the scalp with herpes. If it is the first time to appear the symptoms of headache like pins and needles, must pay attention to check the headache area or neighboring areas have herpes, if found to have herpes, should be formal antiviral treatment, you can take oral acyclovir treatment. If herpes is not found, you can take oral non-steroidal anti-inflammatory drugs, such as diclofenac sodium symptomatic treatment, while oral methylcobalamin nutrition, you can also short-term oral acyclovir antiviral, if the effect is not satisfactory, you can take oral gabapentin. If you have frequent pins and needles headache with neck muscle tension, in addition to oral diclofenac sodium or gabapentin, you can also do acupuncture, massage and other physical therapy. Usually, attention should be paid to avoid prolonged head down to reduce neck muscle strain. It should also be noted that if the symptoms are severe or persistent, a CT or MRI should be performed to rule out cranial lesions.