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Occipital Neuralgia

Occipital Neuralgia

Occipital neuralgia is a cause of headaches. It contains the occipital nerves – (originates from two pairs of nerves located near the second and third vertebrae of the neck). The pain usually begins at the base of the skull by the nape and can 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 primary (spontaneous) or secondary (cause-dependent). Secondary headaches are associated with an underlying disease that may include tumor, trauma, infection, systemic disease, or bleeding.

While any of the following is a cause of occipital neuralgia, many cases can be attributed to chronic neck tension or unknown origins.

  • Osteoarthritis of the upper cervical spine
  • Trauma to the large and / or small occipital nerves
  • Compression of large and / or small occipital nerves or C2 and / or C3 nerve roots from degenerative cervical spine changes
  • Cervical disc disease (very rare)
  • Tumors affecting nerve roots C2 and C3
  • Gout
  •  Diabetes
  •  Blood vessel inflammation (vasculitis)
  • Infection


Symptoms include continuous pain, burning, and throbbing, with intermittent shock or electric shock pain. Pain is often described as migraine-like, and some patients experience other common symptoms for migraine and cluster headaches. The pain usually occurs at the base of the skull and spreads to the back or side of the scalp. Some patients feel pain behind the eye on the affected side. Pain is most often felt on one side of the head, but it can also affect both sides of the head. Neck movements can trigger pain in some patients. The scalp can be sensitive to touch, and an activity like brushing hair can increase a person’s pain.


It can be difficult to distinguish occipital neuralgia from other types of headaches – so diagnosis can be difficult. A comprehensive assessment will include medical history, physical examination, and diagnostic tests. Your doctor can reveal symptoms with questions and determine how much these symptoms will affect the patient’s daily life. If there are abnormal findings in the neurological examination, the doctor may have the following tests:

Magnetic resonance imaging (MRI): Imaging diagnostic test of three-dimensional body structures using powerful magnets and computer technology; It can directly indicate spinal cord obstruction caused by 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, it’s content and the structures around it. It shows abnormal bone structures very well.

Non-Surgical Treatment

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

Percutaneous nerve blocks not only help in the diagnosis of occipital neuralgia but can also help relieve pain. Nerve blocks include occipital nerves or C2 and / or C3 ganglion nerves in some patients. It should be remembered that steroid use can cause serious adverse effects on nerve block therapy.

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 carefully weighed against its risks.

Microvascular decompression involves the identification of blood vessels that can compress the affected nerves and their smooth displacement away from the compression point. “Decompression” can reduce sensitivity and allow nerves to heal and return to a normal, painless state. Treated nerves may include the C2 nerve root, ganglion, and postganglionic nerve.

Occipital nerve stimulation uses a neurostimulator to transmit electrical impulses through insulated lead wires tunneled under the skin near the occipital nerves under the head. Electrical impulses can help prevent pain messages in the brain. The benefit of this procedure is that it is minimally invasive, and nerves and other peripheral structures are not permanently damaged.

If the patient has tried all conservative treatments and still has pain and if the diagnosis is definite, then selective dorsal root rhizotomy should be performed in this method. In this method, success can be applied in cases of bilateral occipital neuralgia, which is usually high and unilateral. It is a very effective method in patients who have been suffering for decades. In this method, there will be permanent numbness behind the nape and head of the patient and partly in front of the neck. In this application, C1-C2 and C3 dorsal nerve roots will be cut. In our experience, the diagnosis should be made if the occipital neuralgia

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