What is Occipital Neuralgia?

Occipital neuralgia explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Occipital Neuralgia DiagramOccipital neuralgia is a condition in which chronic pain occurs within the skull as well as intense pain that spreads through the scalp. According to the International Headache Society, an affected nerve is responsible for the pain in the skull and scalp. More specifically, the pain is often elicited by pressure that is placed on both the major and minor nervus occipitalis. These nerves supply blood to the scalp.

In addition to experiencing pain within the scalp, additional symptoms include:

  • Blurred vision
  • Sensitivity to light
  • Decreased range of motion
  • Pain at both temples on the head
  • Pain behind the eyes

The intensity of the pain that is caused by occipital neuralgia may be mistaken for a tension headache or a migraine. Therefore, a proper diagnosis is critical in order to receive the appropriate treatment. Before a clinical diagnosis can be confirmed, the symptoms and potential triggers are thoroughly evaluated and an occipital nerve block is also performed. If pain relief is experienced after the nerve block, then the condition will be diagnosed as occipital neuralgia.

Causes of Occipital Neuralgia

Occipital NerveDamage or inflammation of the occipitalis nerves causes occipital neuralgia. Nerve entrapment also contributes to the development of this condition. The nerves can become damaged by repetitive neck movements, infection, physical stress, trauma, and infection. Research has also indicated that vascular, neurogenic, osteogenic, and muscular problems may cause occipital neuralgia. Vascular problems refer to inflamed nerve roots; damaged nervous tissue results in neurogenic pain; and osteogenic problems refer to pain that originates in the bones.

Pain may also stem from the following regions: the semispinalis capitis on the superficial side, the trapezius, tight fascia muscles, the atlantoaxial ligament, and the area between the C1 and C2 vertebrae. Additional conditions such as tight cervical muscles, gout, osteoarthritis, diabetes, and neck tumors may also cause occipital neuralgia.

Several tests can be conducted by physicians in order to identify what may be causing occipital neuralgia. The initial evaluation entails gaining an understanding of the patient’s medical history, including any previous occurrence of chronic pain. For instance, symptoms such as dizziness, nausea, and vision problems may be the result of cervical or cranial nerve impingement. After reviewing the medical history, a physical examination known as percussion is performed on regions where specialized nerves are located, to identify tender and painful areas. In certain cases, radiography may be necessary in order to ensure that other underlying conditions are not responsible for the pain.

Treatments for Occipital Neuralgia

RadioFrequency Ablation - XRAYAfter occipital neuralgia has been successfully diagnosed, there are several options for treatment. Common treatment methods include physical therapy and massage therapy, as well as alternative approaches such as acupuncture and chiropractic manipulation. Pharmacological approaches such as antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants, and antiepileptic drugs may also be utilized.

The following are additional noninvasive approaches:

  • An occipital nerve block: This procedure involves injecting local anesthesia and steroids directly at the occipital nerve site, both of which help block pain sensations within the affected nerves. Evidence-based studies have demonstrated the safety and effectiveness of nerve blocks that are used as a diagnostic method and treatment for occipital neuralgia. According to a recent study, patients with occipital neuralgia that underwent an occipital nerve block generally experienced dramatic pain relief.
  • Radiofrequency ablation: This technique entails cauterizing the occipital nerve, thereby preventing it from transmitting pain signals. This approach is suggested if conservative treatment methods have been utilized and deemed ineffective. An assessment regarding the efficacy of radiofrequency ablation, which involved 19 patients who were diagnosed with occipital neuralgia, was recently published in Pain Practice. The results of this clinical trial showed that approximately 68% of the patients experienced a significant reduction in pain one month after undergoing the procedure.
  • Botox injections: Botox or botulinum neurotoxins are injected into the affected region in order to relieve pain by disrupting hyperactive nerves and decreasing muscle activity. It is also suggested that Botox disrupts the activation of neurotransmitters that regulate pain signal transmission. A recent report explains that patients who received Botox injections for chronic headaches experienced a significant reduction in pain that lasted for approximately four weeks.

Conclusion

If a physician suspects that a patient’s neck pain or headaches are being caused by occipital neuralgia, several screening methods are utilized in order to confirm this diagnosis. Diagnostic procedures such as an occipital nerve block have become quite helpful for physicians who want to properly pinpoint the source of the pain. Clinical studies have consistently demonstrated a variety of treatment methods that are effective in reducing the pain that is associated with occipital neuralgia. Therefore, the ability to accurately identify the cause of pain and address the symptoms allows physicians to successfully treat this condition.

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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.