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Occipital Neuralgia

Occipital Neuralgia | American Association of Neurological Surgeons

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

Occipital neuralgia is a headache syndrome that can be either primary or secondary. Secondary headaches are associated with an underlying disease that may include tumor, trauma, infection, systemic disease or hemorrhage.

Although any of the following may be causes of occipital neuralgia, many cases can be attributed to chronic neck tension or unknown origins.

Symptoms include continuous aching, burning and throbbing, with intermittent shocking or shooting pain. The pain often is 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 near the back or along the side of the scalp. Some patients experience pain behind the eye on the affected side. The pain is felt most often on one side of the head, but may also 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 like brushing the hair may increase a person's pain.

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 diagnostic tests. A doctor can document symptoms and determine the extent to which these symptoms affect a patient's 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.

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

Percutaneous nerve blocks not only may be helpful in diagnosing occipital neuralgia, but they can help alleviate pain as well. 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 the use of steroids in nerve block treatment may cause serious adverse effects.

Surgical intervention may be considered when the pain is chronic and 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 normal, pain-free condition. The nerves treated may include the C2 nerve root, ganglion and postganglionic nerve.

Occipital nerve stimulation uses a neuro-stimulator to deliver 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.

The following websites offers additional helpful information on trigeminal neuralgia and its causes, treatment options, support and more. (Note: These sites are not under the auspices of AANS, and their listing here should not be seen as an endorsement of the sites or their content.)

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

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