Occipital Neuralgia

Occipital Neuralgia

By Daniel Weiss, BSc Level IV, McMaster University

Introduction

Occipital neuralgia is a neurological condition characterized by inflammation or irritation of the occipital nerves. The occipital nerves run from the top of the cervical spine at the back of the neck, up through the posterior scalp. Occipital neuralgia may be confused with other types of head pains, especially migraines, due to the similarities in their symptoms. Occipital neuralgia needs to be properly diagnosed, as treatments for other types of headaches may not be effective in treating its symptoms.

Signs and symptoms

  • aching, burning, throbbing pain starting from the base of the posterior skull and radiating up through the posterior scalp – sometimes projecting over the scalp, as far as the temples or forehead
  • pain behind the eye
  • pain in the neck, temple, and frontal regions
  • pain usually worsened by rotation of the neck or pressure over the occipital nerves

Causes

  • can be primary or secondary
  • primary headaches are those that exist independently from other medical conditions, while secondary headaches may be caused by an underlying disease or injury
  • many of the following may be causes of occipital neuralgia, but some cases can be attributed to chronic neck tension or to unknown causes:
    • osteoarthritis of the upper cervical spine
    • trauma to the occipital nerves (back of the head)
    • a whiplash-type injury due to a motor vehicle accident
    • compression of the occipital nerves due to degenerative cervical spine changes or localized muscle spasm
    • tumours in the neck
    • cervical disc disease
    • gout
    • diabetes
    • blood vessel inflammation
    • infection

Diagnosis

It can sometimes be difficult to distinguish occipital neuralgia from other types of head pains, which makes the diagnosis challenging. It is necessary to take a complete medical history, do a careful physical examn and sometimes order diagnostic tests.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans are often used to identify secondary causes. One effective tool for diagnosis is an occipital nerve block, using local anesthetic. This will temporarily alleviate the pain and distinguish occipital neuralgia from other types of headaches with similar symptoms.

Treatment approach

Treatment options vary, depending on the cause of the inflammation and/or irritation of the occipital nerves. The first goal is to relieve pain. There are a number of strategies that can help alleviate the symptoms of occipital neuralgia.

Non-drug therapies

Some non-drug therapies can help to reduce pain levels and enhance pain coping. They include:

  • applying heat to the back of the neck
  • relaxing in a quiet room
  • massaging and stretching tight and painful neck muscles
  • mindfulness-based meditation

These self-management strategies can help you to improve your function so you can do more and enjoy life more.

Medicines

Certain medicines can be taken to relieve some of the symptoms. These include:

  • topical liniments or topical anti-inflammatory lotions.
  • certain oral anti-inflammatory drugs, such as naproxen or ibuprofen are available over the counter.
  • prescription muscle relaxants.
  • anticonvulsant drugs, such as gabapentin or pregabalin
  • certain antidepressant medications such as tricyclics or duloxetine
  • short-term use of local nerve blocks and cortisone injections

Some of these medicines can have adverse side effects. Speak to your doctor, as he or she may not recommend these treatments be used for extended periods of time.

Invasive therapies

One option is occipital nerve stimulation. In this procedure, an implanted neurostimulator is used to deliver electrical impulses to the occipital nerves. These electrical impulses can help block pain messages sent to the brain.
In some severe persistent cases, surgical decompression of the occipital nerve may be considered if the pain does not respond to any other previously mentioned treatments.

For more information

Web Sites

American Association of Neurological Surgeons
https://www.aans.org/

Medline Plus (U.S. National Library of Medicine and the National Institutes of Health)
http://www.nlm.nih.gov/medlineplus/migraine.html

Michigan Headache & Neurological Institute
http://www.mhni.com

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

References

Ducic  I, Felder JM. 3rd,  Fantus, SA. A systematic review of peripheral nerve interventional treatments for chronic headaches. Ann Plast Surg. 2014;72(4);439-445.

Kapural L, Sable, J. Peripheral nerve stimulation for occipital neuralgia: Surgical leads. Prog  Neurol Surgy. 2011;24:86-95.

Palmisani S, Al-Kaisy A., Arcioni R., et al. Martelletti, P.  A six year retrospective review of occipital nerve stimulation practice--controversies and challenges of an emerging technique for treating refractory headache syndromes. J Headache Pain. 2013;14, 67-2377-14-67.

Palmisani S, Al-Kaisy A, Arcioni R, et al. A six year retrospective review of occipital nerve stimulation practice--controversies and challenges of an emerging technique for treating refractory headache syndromes. J Headache Pain. 2013;14: 1129-2377-14-67.

Pedraza MI., Ruiz M, Rodriguez C, et al. Occipital neuralgia: Clinical and therapeutic characteristics of a series of 14 patients. Rev Neurol. 2013;57(5):193-198.