BACKGROUND: Headaches among military personnel are very common and headgear wear is a frequently identified culprit. Helmet wear may cause migrainous headaches, external compression headache, other primary cranial neuralgias, and occipital neuralgia. The clinical features and the response to treatment allow distinction between the different types of headaches. Headaches among aviators are particularly concerning as they may act as distractors while flying and the treatment options are often incompatible with flying status.CASE REPORT: A 24-yr-old door gunner presented with suboccipital pain associated with the wear of his helmet. He described the pain as a paroxysmal stabbing sensation coming in waves. The physical exam and history supported the diagnosis of primary occipital neuralgia. Systemic pharmacological options were discussed with the soldier, but rejected due to his need to remain in flying status. An occipital nerve block was performed with good clinical results, supporting the diagnosis of occipital neuralgia and allowing him to continue as mission qualified.DISCUSSION: Occipital neuralgia can be induced by helmet wear in military personnel. Occipital nerve block can be performed in the deployed setting, allowing the service member to remain mission capable and sparing him/her from systemic side effects.Chalela JA. Helmet-induced occipital neuralgia in a military aviator. Aerosp Med Hum Perform. 2018; 89(4):409–410.