Back to Conditions & Treatments by Subspecialty

Occipital Neuralgia

November, 2006

Occipital neuralgia is a common cause of headache. It involves the two pairs of nerves that originate in the area of the second and third vertebrae of the neck – the occipital nerves. The pain typically starts at the base of the skull by the nape of the neck and may radiate to the back, front, and side of the head, as well as behind the eyes.

Causes

Although any of the following may be causes of occipital neuralgia, many cases can be attributed to chronically contracted neck muscles/neck tension or are idiopathic (unknown).

Osteoarthritis of the upper cervical spine Trauma to the greater and/or lesser occipital nerves Compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes Cervical disc disease Tumors affecting the C2 and C3 nerve roots Gout Diabetes Blood vessel inflammation Infection

Symptoms

Symptoms include aching, burning, and throbbing pain that is continuous, with intermittent, shocking, or shooting pain. The pain is often described as migraine-like and some patients experience other symptoms common to migraines and cluster headaches. The pain usually originates at the base of the skull and radiates to the posterior and/or lateral scalp. Some patients experience pain behind the eye on the affected side. The pain is most often unilateral, but may affect both sides of the head. Neck movements may trigger pain in some patients. The scalp may be tender to the touch and an activity such as brushing the hair may increase a person’s pain.

Diagnosis

It can be difficult to distinguish occipital neuralgia from other types of headaches, thus diagnosis may be challenging. A thorough evaluation will include a medical history, physical examination, and possibly, diagnostic tests. Your doctor will document your symptoms and determine the extent to which these symptoms affect your daily living. If there are abnormal findings on a neurological exam, the doctor may order the following tests:

Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show direct evidence of spinal cord impingement from bone, disc, or hematoma. Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.

Nonsurgical Treatment

The goal of treatment is to alleviate the pain. Often, symptoms will improve or disappear with heat, rest, physical therapy including massage, anti-inflammatory medications, and muscle relaxants. Oral anticonvulsant medications such as carbamazepine and gabapentin may also help alleviate pain.

Percutaneous nerve blocks may not only be helpful in diagnosing occipital neuralgia, but can also help alleviate pain. Nerve blocks involve either the occipital nerves or in some patients, the C2 and/or C3 ganglion nerves. It is important to keep in mind that repeat blocks using steroids may cause serious adverse effects.

Surgery

Surgical intervention may be considered when the pain is chronic, severe and does not respond to conservative treatment. The benefits of surgery should always be weighed carefully against its risks.

Microvascular decompression involves microsurgical exposure of the affected nerves, identification of blood vessels that might be compressing the nerves, and gentle displacement of these away from the point of compression. "Decompression" may reduce sensitivity and allow the nerves to recover and return to a more normal, pain-free condition. The nerves treated may include the C2 nerve root, ganglion and postganglionic nerve.

Occipital Nerve Stimulation uses a neurostimulator which delivers electrical impulses via insulated lead wires tunneled under the skin near the occipital nerves at the base of the head. The electrical impulses can help block pain messages to the brain. The benefit of this procedure is that it is minimally invasive and the nerves and other surrounding structures are not permanently damaged.