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Occipital Neuralgia

Pain that pierces

Occipital Neuralgia is a condition in which one or both occipital nerves, the nerves that run through the scalp, are injured or inflamed. This causes sharp headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears. The pain can feel as if it is also coming out from the back of the eye.

Causes

Occipital neuralgia can be the result of pinched nerves or muscle tightness in the neck. It can also be caused by a head or neck injury. It can also be caused by a stretching on the nerve during surgery.  Occipital neuralgia can either be primary or secondary. A secondary condition is associated with an underlying disease.
Although any of the following may be causes of occipital neuralgia, many cases can be attributed to  other types of 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
  • Gout
  • Diabetes
  • Blood vessel inflammation
  • Infection

Symptoms

Symptoms of occipital neuralgia include continuous aching, burning and throbbing, with intermittent shocking or shooting pain that generally starts at the base of the head and goes to the scalp on one or both sides of the head. Patients often have pain behind the eye of the affected side of the head. Additionally, a movement as light as brushing hair may trigger pain. The pain is often described as migraine-like and some patients may also experience symptoms common to migraines and cluster headaches.

Non Surgical Treatments

  • Heat: patients often feel relief when heating pads or devices are placed in the location of the pain. Such heating pads can be bought over-the-counter or online.
  • Physical therapy or massage therapy.
  • Oral Medication:
  • Anti-inflammatory medications;
  • Muscle relaxants; and
  • Anticonvulsant medications.
  • Percutaneous nerve blocks: these injections can be used both to diagnose and treat occipital neuralgia.
  • Botulinum Toxin (Botox) Injections: Botox injections can be used to decrease spasm at the muscle but will not directly treat the nerve problem. 

Surgery

  • Occipital Nerve Stimulation: This surgical treatment involves the placement of electrodes under the skin near the occipital nerves. The procedure works the same way as spinal cord stimulation and uses the same device. The procedure is minimally invasive and surrounding nerves and structures are not damaged by the stimulation. It is an off-label indication for an FDA-approved device.
  • Spinal Cord Stimulation: this surgical treatment involves the placement of stimulating electrodes between the spinal cord and the vertebrae. The device produces electrical impulses to block pain messages from the spinal cord to the brain.
  • C2,3 Ganglionectomy– This treatment involves the disruption of the second and third cervical sensory dorsal root ganglion. Acar et al (2008) studied the short-term and long-term effects of this procedure. The study found that 95% of patients had immediate relief with 60% maintaining relief past one year.