Cranial neuralgia is a rare form of headache disorders characterized with transient and unilateral attacks. Inflamatuar diseases and cervical compression are amongst the most common etiological factors even so idiopathic forms might be observed. International Classification of Headache Disorders (ICHD-2)made the classification of cranial neuralgias in 18 different groups. Occipital neuralgia, being a subgroup of cranial neuralgies, is a headache that involves anatomically at major, minor or third occipital nerve areas sometimes accompanying with sensory deficits or dysesthesia. Occipital neuralgia includes aching burning or throbbing headache that is often unilateral and continuous with intermittent shocking and shooting pain on the occipital nerve area. Patients with occipital neuralgia can be divided into those with structural causes and those with idiopathic causes. Structural lesions are cervical disc diseases, trauma, compression of the cervical discs. Tumors rarely metastasize to the paravertebral region and compression of the cervical nerve roots may result in occipital neuralgia. Our aim is to present a case with late onset medical refractory occipital neuralgia due to metastatic prostate cancer, emphasizing that relevant medical history should alert clinicans to the possibility of metastasis causing occipital neuralgia.