The findings in 23 cases of occipital neuralgia are presented. The clinical features of the condition are pain and sensory change in the distribution of the relevant nerve, localised nerve trunk tenderness and a clear response to local forms of therapy. The clinical picture is often complicated by migrainous and trigeminal nerve features and the mechanisms by which these come about are discussed. Occipital neuralgia is generally neglected in both the standard textbooks and the literature. The condition occurs sufficiently commonly to warrant more consideration in the differential diagnosis of head pain than it has received to date.