Nerve Pain – Occipital Neuralgia


Occipital Neuralgia Symptoms

Occipital Neuralgia predominately manifests in the nape or lower area of the neck. It is often described as a throbbing and migraine-like pain, spreading upwards in a ‘rams horn’ pattern on the side of the head. It can ultimately spread up to the entire scalp and forehead. Tenderness in the scalp can even turn brushing hair into a painful experience. Pain and pressure is also felt behind the eyes, which in turn can become sensitive to light.

Occipital neuralgia is one of the most severe forms of neuropathic (nerve) pain, but is often misdiagnosed as a migraine or other type of headache, due to the similarity of symptoms.



Occipital Neuralgia Causes

Occipital neuralgia occurs when the occipital nerve that runs from the base of the skull becomes injured, inflamed or irritated. The occipital nerves are two pairs of nerves that originate in the area of the second and third vertebrae of the neck. Osteoarthritis, diabetes or cervical disc disease can also lead to its onset. Other key reasons include localised infection or inflammation, gout, whiplash injuries, diabetes, blood vessel inflammation and tumours.

The term ‘occipital neuralgia’  is also often used to describe a cycle of pain-spasm-pain, starting in 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.  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.


Occipital Neuralgia Treatment

Overall treatment options for occipital neuralgia include anti-neuropathic (nerve pain) 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, an occipital nerve block can be used.

If an occipital nerve block is successful but lasts less than 3-4 months, pulsed radiofrequency to the occipital nerve can be performed.  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 scan) is usually advised. The tumor, if present, is then removed surgically.

Conservative treatments relate to any treatments that are not invasive and, in the case of occipital neuralgia, there are several conservative treatments available. These may take the form of intense massage, physiotherapy (often quite intensive), the application of heat, steroids and so on.