What Is Occipital Neuralgia? | PainDoctor.com

What Is Occipital Neuralgia?

If you experience a chronic ache at the base of the skull that sends sharp, shooting pain radiating to your scalp, you may be suffering from a condition known as occipital neuralgia.

Occipital Neuralgia Symptoms

Typical occipital neuralgia symptoms may include:

  • Bilateral head pain
  • Pain behind the eyes
  • Pain at the base of the skull
  • Dizziness
  • Light sensitivity
  • Decreased neck range of motion
  • Blurry vision, or other vision problems

Must-watch occipital neuralgia video

Causes Of Occipital Neuralgia

Irritation or damage to the nervus occipitalis major or minor can result in occipital neuralgia. There are various reasons why these nerves become inflamed or entrapped. Damage to the nerves can be caused by:

  • Trauma
  • Stress
  • Infection
  • Repeated movements of the neck, including cervical extension and flexion

Research has focused on four specific causes of occipital nerve pain, including:

  • Vascular sources that involve nerve root irritation
  • Neurogenic sources that involve pain that originates in the nervous tissue
  • Muscular sources that involve pain that originates from the muscles of the body
  • Osteogenic sources that involve pain that originates from the bones of the body

Occipital Neuralgia Anatomy | PainDoctor.com

There are various areas where pain can occur in the body for occipital neuralgia patients, including:

  • The space between the C1 and C2 vertebrae
  • Tight fascia muscles
  • The deep layer of the trapezius muscle
  • The superficial layer of the semispinalis capitis muscle
  • The atlantoaxial ligament where the dorsal ramus arises

A variety of comorbid conditions can also occur with occipital nerve pain, including:

  • Cervical spine tumors
  • Gout
  • Diabetes
  • Osteoarthritis
  • Chronic muscle spasm in the cervical musculature

How Is Occipital Neuralgia Diagnosed?

Symptoms of occipital neuralgia are similar to those of tension type headaches and migraine and are therefore often misdiagnosed. However, a correct diagnosis is needed to find effective treatment. To accurately diagnose occipital neuralgia, physicians will conduct a thorough history and physical exam. Once this condition is suspected, an occipital nerve block can be performed. If pain relief is reported from the nerve block, a diagnosis of occipital neuralgia is confirmed.

In order to determine the cause of occipital neuralgia, a detailed history and physical exam will be performed. Questions relating to vision changes, dizziness, as well as nausea or vomiting will help to determine if there is impingement of the cranial or cervical nerves. In addition, doctors perform various assessment tests including percussion of the nervus occipital major and minor in an attempt to elicit tenderness.

Physicians may also order special imaging procedures such as X-rays, computer tomography (CT), or magnetic resonance imaging (MRI) to rule out any underlying pathology.

Occipital Neuralgia | PainDoctor.com

Occipital Neuralgia Treatments

After a diagnosis of occipital neuralgia is confirmed, a comprehensive pain management treatment plan will be developed to help manage your symptoms. Home remedies for occipital neuralgia that is fairly mild may include:

  • Relaxation practices
  • Yoga
  • Meditation
  • Hot or cold therapy for the neck

If your occipital neuralgia pain doesn’t respond to these at-home remedies, you can try some complementary therapies. A number of these conservative treatment options exist, and do help patients reduce pain. They include:

These treatment options are usually recommended as a first line treatment, after at-home remedies, because they are non-invasive and provide pain relief in many cases. They also have few side effects and can be used in conjunction with other therapies or medications. Chiropractic care, physical therapy, and massage are all designed to reduce stress and tension in the body, which can then reduce tension along the occipital nerve.

Likewise, acupuncture for occipital neuralgia is suggested to release endorphins into the body, that can then reduce pain and improve overall quality of life.

Complementary therapies are an important part of any chronic pain management plan. When talking to a doctor, ask how you can use these therapies along with any more advanced therapies they recommend. While chiropractic or other therapies won’t cure occipital neuralgia pain, they can reduce overall pain, the amount of days you experience pain, and improve other aspects of your life.

Chiropractic for Occipital Neuralgia | PainDoctor.com

Medications for occipital neuralgia 

Traditional pharmacological management for this condition involves the use of:

However, for true cases of occipital nerve pain, many patients won’t find much relief through traditional medications. Instead, interventional treatments can be one of the best occipital neuralgia treatments, especially for those who suffer from moderate to severe pain.

Interventional occipital neuralgia treatments

If patients do not respond to conservative measures and pharmacological management, there are additional therapies that can be offered which are relatively non-invasive. These occipital neuralgia treatments include:

Occipital nerve blocks entail injecting a local anesthetic in combination with a steroid into the area of the occipital nerve. The injection helps to block pain sensation of the occipital nerve. Patients receiving occipital nerve blocks usually report significant pain reduction. Research has shown that occipital nerve blocks are a safe and effective diagnostic and therapeutic option for patients suffering from occipital neuralgia.

Injections using Botox are another option that may be offered to patients who suffer from occipital nerve pain. They involve injecting botulinum neurotoxins into the tissue, which help to block nerve impulses that are overactive. It has been suggested that the Botox toxin influences the pain sensory system by interfering with neurotransmitter release. A study published in Current Pain and Headache Reports found that patients had significant reductions in headache pain for the four-week period following treatment with Botox injections.

If all other treatment options fail, radiofrequency ablation may be recommended. Radiofrequency ablation involves inserting a probe through the skin to deliver a high-frequency electrical current to disrupt nerve conduction. In a prospective trial published in Pain Practice, more than 68% of patients suffering from occipital neuralgia reported decreased pain within one month of having radiofrequency ablation. While this study was small, having only 19 participants, it suggests that treatment using radiofrequency ablation may prove to be an effective treatment option for individuals who do not respond to conservative treatment methods.

Occipital Neuralgia Treatments | PainDoctor.com

Surgery for occipital neuralgia

In rare cases, your doctor may suggest surgery for your pain. Surgery should only be done when all other, less invasive options have been tried. If your pain hasn’t responded to other treatments, your doctor may suggest:

  • Microvascular decompression
  • Occipital nerve stimulation

Again, while surgery may be the best option for some patients, make sure you’ve exhausted other options before undergoing surgery. If you haven’t attempted interventional treatments coordinated with complementary therapies, talk to your doctor about what options you may have.

Conclusion

If occipital neuralgia is the suspected cause of your headache pain, your physician will conduct a history and physical exam and then perform an occipital nerve block to confirm your diagnosis. Once the cause of your occipital neuralgia pain is determined, your doctor will work with you to find an appropriate treatment to help you manage your symptoms. Although this condition can be extremely painful, it can be successfully treated with home remedies, complementary therapies like chiropractic care, or interventional treatments like occipital nerve blocks.

If you want to talk to an occipital neuralgia doctor in your area, click the button below to get in touch with a doctor who specializes in pain management. They can answer any questions you have and help you find a path towards less pain.

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References

  1. Aerts K, Vanelderen P, De Vooght P, et al. Pulsed radiofrequency for the treatment of occipital neuralgia. European J Pain. 2009;13;55-85.
  2. Bogduk N, Govind J, Cervicogenic headache: An assessment of evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. 2009;8:959-968.
  3. Hoppenfield JD. Cervical facet arthropathy and occipital neuralgia: Headache culprits. Curr Pain Headache Rep. 2010;14:418-423.
  4. Vanelderen P, Lataster A, Levy R, et al. Occipital Neuralgoa. Pain Practice. 2010;10(2):137-144.
  5. Young W, Blocking the greater occipital nerve: Utility in headache management. Curr Pain Headache Rep. 2010;14;404-408.

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