Occipital Neuralgia

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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. This can sometimes be accompanied by decreased sensation or tenderness in the affected area. While the pain is usually at the back of the head, it can radiate towards the front of the head. The headache is usually unilateral (on one side), but can be bilateral (on both sides of the head).


Contents

Signs and Symptoms

Typically, the pain of occipital neuralgia begins in the neck and then spreads upwards. Some individuals will also experience pain in the scalp, forehead, and behind the eyes.


Causes

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.


Diagnosis

A thorough headache history and medical history and physical examination are done to characterize the symptoms and rule out other disease processes. An X-ray of the upper spine may be helpful to rule out disease that may be causing the pain.

The diagnosis of occipital neuralgia is generally made by eliciting tenderness over the affected nerve. In addition, relief from pain after an anesthetic nerve block will confirm the diagnosis.


Treatment

Treatment is generally symptomatic and includes massage and rest. In some cases, antidepressants may be used when the pain is particularly severe. Other treatments may include local nerve blocks and injections of steroids directly into the affected area.

Clinical Trials

No clinical trials relating to occipital neuralgia were found at this time.


Research

  • Patients with Multiple Sclerosis presented with occipital neuralgia and a relapse of MS. Symptoms responded well to high dose corticosteroids. Relapse should be considered in patients with MS who present with occipital neuralgia. [1]
  • The use of implanted occipital nerve stimulators appears to be an effective treatment option for chronic headache, including occipital neuralgia. [2]
  • Although not every patient is a candidate, cervical ganglionectomy (surgical removal of a nerve tissue mass) can be an effective treatment option for occipital neuralgia. [3]
  • The relationship of the occipital artery to the occipital nerve may be a contributing cause of occipital neuralgia. [4]


Expected Outcome

Occipital neuralgia is not a life-threatening condition. Many individuals will improve with therapy involving heat, rest, anti-inflammatory mediations, and muscle relaxants. Recovery is usually complete after the bout of pain has ended and the nerve damage repaired or lessened.


References

  1. De Santi L, Monti L, Menci E, Bellini M, Annunziata P. Clinical-Radiologic Heterogeneity of Occipital Neuralgiform Pain as Multiple Sclerosis Relapse. Headache. 2008 Jul 21. (Epub ahead of print) Abstract
  2. Jasper JF, Hayek SM. Implanted occipital nerve stimulators. Pain Physician. 2008 Mar-Apr;11(2):187-200. Abstract | PDF
  3. Acar F, Miller J, Golshani KJ, Israel ZH, McCartney S, Burchiel KJ. Pain relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia. Stereotact Funct Neurosurg. 2008;86(2):106-12. Epub 2008 Jan 24. Abstract
  4. Shimizu S, Oka H, Osawa S, et al. an proximity of the occipital artery to the greater occipital nerve act as a cause of idiopathic greater occipital neuralgia? An anatomical and histological evaluation of the artery-nerve relationship. Plast Reconstr Surg. 2007 Jun;119(7):2029-34; discussion 2035-6. Abstract

External Links

National Headache Foundation

American Chronic Pain Association

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