What is occipital neuralgia?

Woman holding the back of her neck.
Occipital neuralgia causes pain along the upper neck and the back of the head.

Occipital neuralgia is a form of headache that causes pain along the upper neck and back of the head. The pain is in the distribution of the nerves known as occipital nerves (sensory nerves that run from the upper part of the neck to the back of the head). The pain can be throbbing, aching, burning, or can feel sharp and stabbing. Sometimes, this condition is referred to as occipital neuritis, suggesting there are some associated inflammatory changes that have affected the occipital nerves.

What are the symptoms and signs of occipital neuralgia?

Although the symptoms of occipital neuralgia can vary from person to person, most patients will experience pain along the neck where it meets the skull, as well as pain along the back of the head. The pain might be one-sided or bilateral (located on both sides of the head). The pain might be sharp or stabbing, or feel like an electric shock along the nerve. Sometimes that pain is a dull aching or throbbing. The pain often can travel along the side of the head, sometimes as far forward as the forehead. There can be some symptoms that are frequently seen with migraine headache or other headaches, including sensitivity to light or sound, or scalp tenderness. Patients with this type of headache may have increased pain when moving their neck.

If the pain caused by occipital neuralgia travels along the side of the head to the face, it might initially be mistaken for a condition known as trigeminal neuralgia . However, physical examination and assessment of the history of the pain should reveal important differences that will help lead to the correct diagnosis.

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Occipital Neuralgia Symptoms: Neck Pain

Pain in the neck can be more than just a hassle. Neck pain can come from disorders and diseases of any structure in the neck. There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical vertebrae) that surround the spinal cord and canal. Between these vertebrae are discs and nearby pass the nerves of the neck. Within the neck, structures include the:

  • neck muscles,
  • arteries, veins,
  • lymph glands,
  • thyroid gland,
  • parathyroid glands,
  • esophagus, larynx, and
  • trachea.

Disease of any of these structures can lead to neck pain.

What causes occipital neuralgia?

The cause of occipital neuralgia is poorly understood. It is thought to occur when the occipital nerves become irritated or inflamed. There can be many different causes of this nerve irritation, including whiplash or other injury to the neck, injury to the back of the head, muscle spasm or recurrent muscle tightness, arthritis of the cervical spine, or other structural changes to the upper cervical spine. Infrequent causes of this type of headache can include diabetes, infection, or inflammation of different blood vessels.

How is occipital neuralgia diagnosed?

There is no test to specifically diagnose or confirm occipital neuralgia. The diagnosis is made on physical examination findings such as a marked tenderness to pressure along the occipital nerve; palpation of this region often will reproduce or worsen the pain that the patient is experiencing. If the patient has tenderness over the distribution of the greater occipital nerve is important in making this diagnosis. There may be some associated muscle tightness or spasm in the neck region. Some doctors perform a nerve block using a local anesthetic to see if this will eliminate or relieve the pain, helping to confirm the diagnosis. X-rays of the neck, CT scan, or MRI scan may be ordered if there is a concern that some underlying problem is causing the symptoms.

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What treatments or surgeries reduce pain from occipital neuralgia?

If the pain persists, daily medications to help calm the nerve may be used. These medications can include anti-seizure medications or antidepressants. Occipital nerve blocks using an injection of a local anesthetic and a steroid agent may be performed. These often are quite successful in relieving the chronic pain for several weeks or months at a time. When combined with physical therapy, daily stretching and strengthening exercises, and other conservative measures, patients with this type of headache can often do well for many weeks or months at a time. Some patients find that a one-time course of physical therapy or a single nerve block alleviates their pain completely.

If the pain fails to respond to conservative treatment options, there are several more invasive therapies that have been shown to be successful. These include:

  • Rhizotomy (destroying the nerve root to eliminate the pain)
  • Neurolysis (applying heat, freezing the nerve, or applying different chemicals to the nerve to block the transmission through the nerve)
  • Implanting an occipital nerve stimulator (similar to a TENS unit).

Decompression surgery to open the area around the nerve also can be performed.

Although a specific cure for occipital neuralgia does not exist, there are many effective symptomatic treatment options

What home therapies help head and scalp pain from occipital neuralgia?

The medical treatment for occipital neuralgia can vary. Often, conservative treatments including heat, massage, rest, physical therapy, muscle relaxants, and anti-inflammatory medications are used as first-line options.

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Can occiptal neuralgia be cured?

For most people, 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.

Can you prevent an occipital neuralgia headache?

For most people, 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.

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Medically Reviewed on 9/6/2019
References
National Institute of Neurological Disorders and Stroke. Occiptal Neuralgia Information Page.
<https://www.ninds.nih.gov/Disorders/All-Disorders/Occipital-Neuralgia-Information-Page>

American Association of Neurological Surgeons. "Occiptal Neuralgia." Updated: Feb 2013.
<http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Occiptal%20Neuralgia.aspx>
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