Occipital Neuralgia

Occipital neuralgia occurs when the occipital nerves, which run from the top of the spinal cord up through the scalp, become injured or inflamed. A fairly uncommon condition, it affects an estimated 3 out of every 100,000 people each year. Certain symptoms, especially the feeling of pain at the back of the head or base of the skull, can resemble those of migraine. However, treatment of occipital neuralgia is different from that of migraine, so clear diagnosis and guidance are essential. ‍

What Causes It?

In primary occipital neuralgia, pain comes directly from irritated nerves. This can happen if occipital nerves are pinched by a head or neck injury or even if muscle tightness entraps the nerves. 

Secondary occipital neuralgia is caused by an underlying medical condition, which could range from osteoarthritis that’s pinching nerves, to a tumor growth affecting nerve roots. 

What Are the Symptoms?

Head pain from occipital neuralgia may feel like a sharp, jabbing electric shock at the back of head and neck; it can also be aching, throbbing, or burning, traveling from the base of the head up to the scalp. Pain can also occur on one or both sides of the head or behind the eye.

Unlike most other types of head pain, pain from occipital neuralgia can be triggered very quickly from something as innocuous as touching the scalp or angling the neck awkwardly. Although episodes of intense pain may last just a few seconds, tenderness around the nerves tends to persist. 

How Is It Diagnosed?

A doctor or headache specialist will diagnose occipital neuralgia by first asking questions about the pain, as well as any injuries past or current. They may press firmly around the neck and scalp to see if they can reproduce the pain.

Nerve block — a shot used to numb a nerve — can also be administered to the occipital region. If it brings relief, occipital neuralgia is likely the diagnosis. 

How Is It Treated?

Non-surgical approaches are generally recommended first. Over-the-counter painkillers, anti-inflammatory medications, and muscle relaxants can work to calm irritated or inflamed nerves. 

Physical therapy or massage therapy may also help with muscle tightness or overactivity that can pinch nerves. A specialist might also prescribe occipital nerve blocks or Botox injections to decrease inflammation of the damaged nerves and numb pain. 

Is It Preventable?

When occipital neuralgia is chronic, a specialist may recommend outpatient occipital release surgery. Through a small incision at the back of the neck, a surgeon can release the nerves from muscle and tissue that might be compressing it.

In some cases, surgical relief provided is temporary and the pain returns. A procedure to cut the greater occipital nerve can lead to scalp numbness and is considered a last resort. 

What Causes It?

In primary occipital neuralgia, pain comes directly from irritated nerves. This can happen if occipital nerves are pinched by a head or neck injury or even if muscle tightness entraps the nerves. 

Secondary occipital neuralgia is caused by an underlying medical condition, which could range from osteoarthritis that’s pinching nerves, to a tumor growth affecting nerve roots. 

What Are the Symptoms?

Head pain from occipital neuralgia may feel like a sharp, jabbing electric shock at the back of head and neck; it can also be aching, throbbing, or burning, traveling from the base of the head up to the scalp. Pain can also occur on one or both sides of the head or behind the eye.

Unlike most other types of head pain, pain from occipital neuralgia can be triggered very quickly from something as innocuous as touching the scalp or angling the neck awkwardly. Although episodes of intense pain may last just a few seconds, tenderness around the nerves tends to persist. 

How Is It Diagnosed?

A doctor or headache specialist will diagnose occipital neuralgia by first asking questions about the pain, as well as any injuries past or current. They may press firmly around the neck and scalp to see if they can reproduce the pain.

Nerve block — a shot used to numb a nerve — can also be administered to the occipital region. If it brings relief, occipital neuralgia is likely the diagnosis. 

How Is It Treated?

Non-surgical approaches are generally recommended first. Over-the-counter painkillers, anti-inflammatory medications, and muscle relaxants can work to calm irritated or inflamed nerves. 

Physical therapy or massage therapy may also help with muscle tightness or overactivity that can pinch nerves. A specialist might also prescribe occipital nerve blocks or Botox injections to decrease inflammation of the damaged nerves and numb pain. 

Is It Preventable?

When occipital neuralgia is chronic, a specialist may recommend outpatient occipital release surgery. Through a small incision at the back of the neck, a surgeon can release the nerves from muscle and tissue that might be compressing it.

In some cases, surgical relief provided is temporary and the pain returns. A procedure to cut the greater occipital nerve can lead to scalp numbness and is considered a last resort. 

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