Occipital neuralgia

• What is Occipital Neuralgia?
• Statistics
• Risk Factors
• Progression
• Symptoms
• Clinical Examination
• How is it Diagnosed
• Prognosis
• Treatment
• References

What is Occipital Neuralgia?

Occipital neuralgia is a very specific type of headache, where the pain is in the back of the head, at the very top of the neck and behind the ears. This location relates to an area supplied by a nerve, called the occipital nerve, which usually gathers information about pain and touch from this exact area. In occipital neuralgia this area can also sometimes not feel normal sensations as well as usual. While it is usually only on one side of the head, it can sometimes be on both.

Risk Factors

Often the exact cause of occipital neuralgia is not found, but some of the more common causes are:

• Trauma (damage) to the back of the head
• ‘Pinching’ (entrapment) of the nerve by overly tight neck muscles
• Osteoarthritis of the bones in the neck, compressing the nerve as it leaves the spine
• Lesions (eg. bone cancers) in the neck (very rare)

Symptoms

The most important questions the doctor will ask will be about the headache and exactly where it is felt. This is because occipital neuralgia occurs in a very specific location. They will also want to rule out other causes that can give similar sorts of symptoms. These can include pain from the muscles of the neck (rather than a nerve) and referred pain from the neck.

Clinical Examination

The only feature of occipital neuralgia that can really be examined is that when you press over the nerve itself then it can be particularly painful.

How is it Diagnosed

The clinical presentation of the condition is far more important in the diagnosis of occipital neuralgia, but there is one test that the doctor may like to do. The doctor may then want to try and numb the occipital nerve by injecting a small amount of local anaesthetic where the nerve runs. If this stops the pain then it is almost diagnostic of occipital neuralgia. They may also want to do an x-ray of the neck to examine the bony structures.

Prognosis

Occipital neuralgia can last for a very long time, but it may stop by itself after a while. Generally, occipital neuralgia is a long-term condition that requires treatment to lessen the pain.

Treatment

Treatment of occipital neuralgia is actually the same as the investigation detailed above. The doctor will want to inject a small amount of local anaesthetic or maybe a steroid into the area. This should stop the pain quite quickly, and the pain relief may last for several weeks. When the pain returns, this can be done again. There are very few complications from this treatment, although some people have been known to get cushing’s syndrome (steroid excess) from repeated steroid injections.
In extreme cases, a small device can be implanted that blocks the pain signals, and in even more severe cases, surgery can be done to take pressure off the nerve, and remove some of the pain fibres.

References

1. Ashkenazi, Avi, Levin, Morris. Three common neuralgias. Post-graduate Medicine 2004; 116:3.
2. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders (Second edition) Cephalalgia 2004;24(Suppl 1):9-160.