Occipital Neuralgia

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).

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.
 * The use of implanted occipital nerve stimulators appears to be an effective treatment option for chronic headache, including occipital neuralgia.
 * 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.
 * The relationship of the occipital artery to the occipital nerve may be a contributing cause of occipital neuralgia.

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.