Occipital neuralgia is a condition in which the nerves that run from the top of the spinal cord up through the scalp, called the occipital nerves, are inflamed or injured. It 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.
It is often confused with a migraine or other types of headache because the symptoms can be similar. But treatments for those conditions are very different, so it’s important to get the right diagnosis.
How occipital neuralgia is different from other Headaches :
Headaches due to occipital neuralgia are frequently quite painful, starting with sharp, stabbing pain, but most people with this condition respond well to treatment and most recover.
It is different from other types of headaches in two ways:
- The cause of the condition
- The specific places where individuals feel pain
Other headaches have more general causes, which can range from sinus infections to high blood pressure to medications and many other potential triggers. But occipital neuralgia only develops when the occipital nerves are irritated or injured. These nerves are found at the second and third vertebrae of the neck.
Occipital neuralgia pain will only develop in areas touched by the greater, lesser, and third occipital nerves. With one on each side of the head, the occipital nerves run from the spine to the scalp, and sensitivity can develop anywhere along this route.
Symptoms of occipital neuralgia :
Occipital neuralgia can cause intense pain that feels like a sharp, jabbing, electric shock in the back of the head and neck. Other symptoms include:
- Aching, burning, and throbbing pain that typically starts at the base of the head and goes to the scalp
- Pain on one or both sides of the head
- Pain behind the eye
- Sensitivity to light
- Tender scalp
- Pain when moving the neck
Causes of occipital neuralgia :
Occipital neuralgia happens when there’s pressure or irritation to your occipital nerves, maybe because of an injury, tight muscles that entrap the nerves, or inflammation. Chronic neck tension is another common cause.
Although many of the following may be causes of occipital neuralgia, many cases can be attributed to chronic neck tension or unknown origins.
- 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
- Blood vessel inflammation
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 following tests may be ordered:
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.
Treatment of occipital neuralgia :
A variety of different treatment options are available for occipital neuralgia. The goal of treatment is to alleviate the pain. To relieve the pain, the following are some home treatment:
- Apply heat to the neck
- Rest in a quiet room
- Massage tight and painful neck muscles
- Take over-the-counter anti-inflammatory drugs
If those are of no help, medications may be prescribed including:
- Muscle relaxants
- Antiseizure drugs
- Nerve blocks and steroid shots. It may take two to three shots over several weeks to get control of the pain. It’s not uncommon for the problem to return at some point and to need another series of injections
Surgical treatment :
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. Surgery may include:
Microvascular decompression: it 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: It involves using a nerve-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.
For most patients, conservative therapy or occipital nerve blocks are quite effective in relieving their pain. For others, more invasive therapies can be quite successful. As with many other conditions, the response to treatments can vary widely. This type of headache does not lead to other neurological conditions or nerve problems, even if left untreated.