Occipital Neuralgia – Symptoms, Causes, and Treatment

Occipital neuralgia is a condition that involves inflammation of occipital nerves that result in electric-shock-like throbbing and shooting headaches. Pain is experienced in the upper neck, back of the head, sometimes radiating as far as the forehead and behind the eye of the affected side of the head. Mostly and always, pain is in half of the head.

Symptoms of occipital neuralgia

The pain is intense, zapping, and piercing in character and is mostly felt on the affected side.

Causes of occipital neuralgia

There can be several causes of occipital neuralgia. However, all the conditions lead to inflammation of the occipital nerve that results in a shooting headache.

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Inflammation can be caused by any of these:

  • A pinched nerve due to arthritis in the upper cervical vertebrae
  • Trauma or injury (like a whiplash injury) to the neck
  • A bad posture tightens the muscles at the back of the neck and shoulders causing inflammation and thus exerting pressure on the occipital nerve
  • A disc hernia may also compress the occipital nerve
  • Inflammation from arteritis may also spread and affect the nerve
  • A viral Infection like herpes simplex can also affect the neurons and thus cause occipital neuralgia
  • Other factors include diabetes and gout

What triggers a headache in occipital neuralgia?

The episode of headache can be triggered due to movements, which include:

  • Bending down
  • Lying down
  • Side-to-side movement of the head
  • Touching the scalp while washing your hair

Management of occipital neuralgia

Diagnosis:

There is no concrete test to diagnose occipital neuralgia. Your doctor might run a series of examinations and investigations to reach a conclusion.

  • Neurological examination: The physician might apply pressure along the course of the occipital nerve to find any signs of inflammation or tenderness.
  • MRI (magnetic resonance imaging): In case your physical and neurological exam is inconclusive, to rule out any other underlying condition, the doctor might ask you to get an MRI done.
  • Occipital nerve block: This is another way to confirm the cause of the shooting and throbbing headache. This procedure includes injecting an anesthetic around the occipital nerve to control the pain. This is just done temporarily. If a patient responds to this treatment, it confirms that he has occipital neuralgia.

Treatment:

Occipital Neuralgia does not have a specific cure. However, all the treatment options are used to relieve the pain. There are two approaches to help with the pain; surgical and nonsurgical.

Nonsurgical

  • Muscle relaxants to relieve the tension in the surrounding muscles
  • Anti-inflammatory medicines such as NSAIDs
  • Injecting steroids around the nerve can decrease the pain, in some patients this treatment works. However, others do not get relief and would eventually move on towards surgical treatment
  • Some other non-surgical treatment options include permanently eliminating the occipital nerve, using a toxin, or a radio wave probe. A drawback of this treatment is numbness and loss of sensations in the scalp innervated by the occipital nerve

Surgical

Surgical decompression of greater occipital nerve:

  • This involves making an incision at the back of the neck and releasing the greater occipital nerve from surrounding implemented tissue and muscles that are exerting pressure on it.
  • In some patients, this treatment provides relief from headaches for a year or two. After that, they eventually return to the doctor with the recurrence of symptoms. At this point, the surgeon has no other option than to cut the occipital nerve. That again causes numbness and loss of sensations at the scalp.

Lifestyle changes and home remedies

  • Most of the patients feel relief by applying heat to the location of the pain
  • Hot massages can also help with occipital neuralgia due to bad posture and muscle tension
  • Physiotherapy can work as a long-term treatment option to avoid rebound headaches caused by occipital neuralgia

When should you see a doctor?

Since headache due to Occipital Neuralgia resembles other common headaches like clusters, migraines, and tension headaches a lot. Thus, in most cases, it goes unrecognized.

However, if you start feeling an unusual zapping and shooting pain that involves your neck as well as your head (most commonly half of the head) accompanied by tenderness of scalp and the associated symptoms don’t include Auras, you should take this headache seriously. If your physician manages to find a problem, he might refer you to a neurologist or a neurosurgeon for further evaluation of the cause.

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FAQ

What is the location of pain in occipital neuralgia?

Headache is experienced in the upper neck, back of the head, behind the ears, and behind the eye of the affected side of the head.

What are the common symptoms of occipital neuralgia?

  • Burning and throbbing pain
  • Tenderness at the scalp
  • Photophobia
  • Pain behind the eyes
  • Pain in half of the head
  • Nausea

What are non-surgical treatment options for occipital neuralgia?

  • Muscle relaxants to relieve the tension in the surrounding muscles
  • Anti-inflammatory medicines such as NSAIDs
  • Injecting steroids around the nerve can decrease the pain
  • Permanently eliminating the occipital nerve, using a toxin, or a radio wave probe

How can I confirm if I’m suffering from occipital neuralgia?

There is no concrete test to diagnose occipital neuralgia. Your doctor might run a series of examinations and investigations to reach a conclusion.

  • Neurological examination
  • MRI (magnetic resonance imaging)
  • Occipital nerve block
Last medically reviewed on July 30, 2021.