Occipital Neuralgia is a condition in which the occipital nerves become damaged or inflamed. The occipital nerves go through the scalp. This can lead to headaches that are severe, throbbing in the upper neck, back of the head or behind the ears.
CAUSES
This can be caused from a compressed nerve or tight neck muscles. It can also be caused by an injury to the head or neck. Occipital neuralgia can be a secondary condition related to another disease or it can be a primary condition. Not all causes of occipital neuralgia are known. Here are some causes:
- Osteoarthritis of the upper cervical spine
- Trauma to the occipital nerves
- Compression of occipital nerves or C2/C3 nerve roots from degenerative cervical spine changes
- Cervical disc disease
- Tumors that affect the C2 or C3 nerve roots
- Gout
- Diabetes
- Blood vessel inflammation
- Infection
SYMPTOMS
Some common symptoms include aching, burning, throbbing, shooting pains from the base of the head to the scalp or to the sides of the head. There is usually pain behind the eyes of the injured side of the head. Small movements can cause pain. The pain is usually severe headaches like migraines that can also cause cluster headaches.
SEEKING CARE
This can be trickier to diagnose due to similarities to migraines or other headache conditions. If the pain is in the neck or scalp and is atypical and sharp and is not causing light sensitivity or nausea, seek help. First talk to a primary care physician.
TESTING AND DIAGNOSIS
There are no tests that will reveal a complete diagnosis. A physical examination and neurological examination should be done to look for signs of occipital neuralgia. An MRI can reveal any impingement and a CT scan can show the size and shape of the structures of the body. Occipital nerve blocks may be used to help the doctor diagnose this condition.
TREATMENT
The goal of treatment is to decrease pain but there is no cure. Treatment may be surgical or nonsurgical.
Nonsurgical approach
- Heat: heating pads over the location of pain may help.
- Physical therapy or massage therapy
- Oral medication: Anti-inflammatory medication, muscle relaxant, anticonvulsant medication
- Percutaneous nerve blocks: Helps with diagnosis and treatment
- Botulinum Toxin (botox) injections: Decrease inflammation of the nerve
Surgery
- Occipital Nerve Stimulation: Placement of electrodes beneath skin near occipital nerves, similar to spinal cord stimulator. This is a minimally invasive procedure and surrounding structures should not be damaged during surgery. This is an off-label indication for FDA approval
- Spinal Cord Stimulation: Placing a device in the body between the spinal cord and vertebrae to block pain signals. The stimulating electrodes inhibit main messages from the spinal cord that go to the brain.
- C2, 3 Ganglionectomy: The second and third cervical sensory dorsal root ganglion will be disrupted during surgery. Acar et al (2008) studied this procedure. The study showed that 95% of patients found the surgery immediately relieving and 60% of people felt relief that lasted for over a year.
FOLLOW UP
It is suggested to continually follow up with a physical to maintain and control treatment. After surgery, the patient should check in with their surgeon every couple of months. A device representative can be visited to adjust the spinal cord stimulator or occipital nerve stimulator device.
