Occipital Neuralgia


Occipital Neuralgia is a form of neuropathic pain caused by irritation or injury to the occipital nerve located in the back of the scalp. The occipital nerves are two pair of nerves that originate in the area of the second and third vertebrae of the neck.

The term is also often used to describe a cycle of pain-spasm-pain, starting at the base of the skull, often radiating to the back, front and side of the head.

Studies report that occipital neuralgia occurs more in women than in men.

Symptoms of Occipital Neuralgia

Individuals with this disorder complain of a pain that originates in the nape or lower area of the neck.

Often described as throbbing and migraine-like, the pain then spreads upward in a “ram’s horn” pattern on the side of the head. It can ultimately spread up to the entire scalp and forehead.

An individual suffering from occipital neuralgia also complains of tenderness in the scalp. It develops tenderness to touch, making even brushing hair a painful experience.

Besides, pain or pressure is also felt behind the eyes, which can become sensitive to light.

However, a chronic headache is widely accepted as the only direct symptom of occipital neuralgia.

Causative Factors

Occipital Neuralgia occurs with an injury to the greater or lesser occipital nerves or some irritation of one or both of these nerves. Other key reasons include:

· Localized infection or inflammation

· Gout

· Whiplash injury

· Diabetes

· Blood vessel inflammation

· Frequent and lengthy periods of keeping the head in downwards and forward position

· Arthritis

· Growth of a tumor

· Physical stress or trauma

· Repeated contraction of the neck muscles Spinal cord compression

· Spinal cord compression

Research also indicates some other causes of occipital neuralgia. A study by Dugan et al. (1962) found it quite common for a patient of occipital neuralgia to be left-handed or having some other evidence of a muscular imbalance or mild neurological problem dating back to early childhood.

Treatment of Occipital Neuralgia

Overall treatment options for occipital neuralgia include anti-neuropathic medications such as Pregabalin and Gabapentin which act to dampen down the overactivity of these damaged nerves.

In cases where pain is refractory (resistant) to anti-neuropathic medication or where treatment is hindered by adverse effects, occipital nerve block can be used. This is a simple injection around the greater and lesser occipital nerves at the base of the scalp with long acting local anaesthetic and anti-inflammatory which can have a dramatic effect in reducing pain.

If occipital nerve block is successful but lasts less than 3-4 months, pulsed radiofrequency of the occipital nerve can be done. This is a simple procedure in which pulsed radiofrequency waves are applied to the occipital nerve, causing them to reset their function.

In addition, in cases where the nerve pain is suspected to be because of a tumor, a computer tomography (CT) is usually done. The tumor, if present, is then removed surgically.