Occipital Neuralgia (Headache) Symptoms, Causes, and Treatment for Pain Relief

  • Medical Author:
    Danette C. Taylor, DO, MS, FACN

    Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is occipital neuralgia?

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 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.

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.

Is there a test to diagnose this type of headache?

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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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 therapies and medical treatment options are available 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.

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

Can occiptal neuralgia be cured?

For most patients, 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 this type of headache be prevented?

In many cases, the cause of occipital neuralgia is not found so it's difficult to determine how to prevent this condition. However, recognizing factors that cause or contribute to muscle tension of the neck and avoiding circumstances which might lead to neck injury is a good place to start.

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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Reviewed on 3/15/2017
References
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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