In five cases of basilar impression proved by roentgenogram and operation, the first and practically the only symptom was severe, intractable occipital headache. In three of these cases there was almost total relief of pain, and in two cases, in which the suboccipital decompression was not done in spite of the presence of basilar impression, little relief was obtained. It is suggested that in cases of severe occipital headache, roentgenographic search for the possibility of basilar impression is advisable.