Occipital Neuralgia

What is occipital neuralgia?
Occipital neuralgia is a distinct type of headache characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side of the head.

What are the symptoms of occipital neuralgia?
The pain from occipital neuralgia begins in the neck and then spreads upwards. Some individuals will also experience pain in the scalp, forehead, and behind the eyes. Their scalp may also be tender to the touch, and their eyes especially sensitive to light. The location of pain is related to the areas supplied by the greater and lesser occipital nerves, which run from the area where the spinal column meets the neck, up to the scalp at the back of the head.

What causes occipital neuralgia?
The pain is caused by irritation or injury to the nerves, which can be the result of trauma to the back of the head, pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumors or other types of lesions in the neck. Localized inflammation or infection, gout, diabetes, blood vessel inflammation (vasculitis), and frequent lengthy periods of keeping the head in a downward and forward position are also associated with occipital neuralgia. In many cases, however, no cause can be found.

How is occipital neuralgia diagnosed?
Occipital Neuralgia is diagnosed based on a thorough history and physical exam. The neurologic exam will often be normal. During the exam, the practitioner will push on the occipital nerves in an effort to temporarily elicit a pain response. By diagnostic criteria, the pain will be eased temporarily by injection of a local anesthetic along the affected nerve (occipital nerve block).

What are the treatments for occipital neuralgia?
Conservative methods: include warm compresses, massage, and physical therapy. Anti-inflammatory medications and muscle relaxers, such as flexeril, may provide relief of symptoms. Antiepileptic drugs (such as gabapentin, and pregabalin), and tricyclic antidepressants (Elavil) are often used as preventative medications in an effort to decrease the frequency and severity of attacks
Occipital Nerve block: is an injection of a local anesthetic and steroid around the greater and lesser occipital nerves that are located on the back of the head just above the neck area. The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the nerves and surrounding structures. Typically, headaches over the back of the head, including certain types of tension headaches and migraine headaches, may respond to occipital nerve blocks.
C2 Nerve Root block: is and injection near the origin of the occipital nerves which may be more effective than the more superficial occipital nerve block. The procedure is performed with either live X-ray or live CT guidance and an injection of local anesthetic and steroid is placed around the C2 nerve where it exits the spinal canal targeting the nerves that give rise to the occipital nerves.

Spinal Cord Stimulation (SCS): An implanted electrical device can decrease the perception of pain by targeting the spinal cord and brain pain processing centers. Before the surgical implantation, a one week minimally invasive trial is performed to see if this device will help you long-term. If there is significant pain decrease and an increase in functional ability during the trial, you would be a candidate to have a permanent SCS device implanted.

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