Occipital Neuralgia

A colleague was recently told he had Occipital Neuralgia. It has caused debilitating headaches for him which prompted a visit to his neurologist. Steroid injections were recommended, but he declined for now. Here is more information for our patients. 

Occipital Neuralgia

Occipital neuralgia is a neurological condition in which the occipital nerves — the nerves that run from the top of the spinal cord at the base of the neck up through the scalp — are inflamed or injured. Occipital neuralgia can be confused with a migraine, or other types of headache, because the symptoms can be similar. But occipital neuralgia is a distinct disorder that requires an accurate diagnosis to be treated properly.

Symptoms of Occipital Neuralgia

Occipital neuralgia can cause very intense pain that feels like a sharp, jabbing, electric shock in the back of the head and neck. Other symptoms of occipital neuralgia may include:
  • Aching, burning, and throbbing pain that typically starts at the base of the head and radiates to the scalp
  • Pain on one or both sides of the head
  • Pain behind the eye
  • Sensitivity to light
  • Tender scalp
  • Pain when moving the neck

Causes of Occipital Neuralgia

Occipital neuralgia is the result of compression or irritation of the occipital nerves due to injury, entrapment of the nerves, or inflammation. Many times, no cause is found.
There are many medical conditions that are associated with occipital neuralgia, including:
  • Trauma to the back of the head
  • Neck tension and/or tight neck muscles
  • Osteoarthritis
  • Tumors in the neck
  • Cervical disc disease
  • Infection
  • Gout
  • Diabetes
  • Blood vessel inflammation

Diagnosing Occipital Neuralgia

If you think you may have occipital neuralgia, make an appointment with your doctor. Your doctor will ask questions about your medical history and any injuries you may have had, perform a physical exam, and may order certain tests, such as blood tests or an MRI scan. Your doctor may also give you an anesthetic nerve block to see if it relieves the pain. If it works, occipital neuralgia is likely the cause of the pain.
For treatment to work, it is very important that you receive an accurate diagnosis. For example, if you have occipital neuralgia and are prescribed migraine medication, you may not get relief. 

Treatments for Occipital Neuralgia

Treatment depends on what is causing the inflammation or irritation of the occipital nerves. The first course of action is to relieve pain. There are a number of things you can try to get relief, including: 
  • Apply heat to the neck.
  • Rest in a quiet room.
  • Massage tight and painful neck muscles.
  • Take over-the-counter anti-inflammatory drugs, like naproxen (such as Aleve) or ibuprofen (such as Motrin).
If these self-care measures don’t work, your doctor may prescribe the following medications to treat occipital neuralgia pain:
Surgery may be considered if pain does not respond to other treatments or comes back. Surgery may include:
  • Microvascular decompression. During this procedure, your doctor may be able to relieve pain by identifying and adjusting blood vessels that may be compressing the nerve.
  • Occipital nerve stimulation. In this procedure, a neurostimulator is used to deliver electrical impulses to the occipital nerves. These electrical impulses can help block pain messages to the brain.
Occipital neuralgia is not a life-threatening condition. Most people get significant pain relief by resting and taking medication. However, if you do not get relief and continue to experience neck and head discomfort, tell your doctor. There may be another reason for your pain that should be considered.
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