Occipital neuralgia is a common cause of headache. It involves the occipital nerves, two pairs of nerves that originate near the second and third vertebrae of the neck. The pain typically starts at the base of the skull by the nape of the neck and may spread to the area behind the eyes and to the back, front and side of the head. Causes Occipital neuralgia is a headache syndrome that can be either primary or secondary. Secondary are associated with an underlying disease that may include tumor, trauma, infection, systemic disease or hemorrhage. Although any of the following may be causes of occipital neuralgia, many cases can be attributed to chronic neck tension or unknown origins.
Osteoarthritis of the upper cervical spine
Trauma to the greater and/or lesser occipital nerves
Compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes
Cervical disc disease
Tumors affecting the C2 and C3 nerve roots
Blood vessel inflammation
Symptoms Symptoms include continuous aching, burning and throbbing, with intermittent shocking or shooting pain. The pain often is described as migraine-like, and some patients experience other symptoms common to migraines and cluster headaches. The pain usually originates at the base of the skull and radiates near the back or along the side of the scalp. Some patients experience pain behind the eye on the affected side. The pain is felt most often on one side of the head, but may affect both sides of the head also. Neck movements may trigger pain in some patients. The scalp may be tender to the touch, and an activity like brushing the hair may increase a person's pain.
Diagnosing Occipital Neuralgia MRI Scan: A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show direct evidence of spinal cord impingement from bone, disc or hematoma. CT Scan: A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents and the structures around it.
Nonsurgical Treatment The goal of treatment is to alleviate the pain. Often, symptoms will improve or disappear with heat, rest and/or physical therapy, including massage, anti-inflammatory medications, and muscle relaxants. Oral anticonvulsant medications such as carbamazepine and gabapentin also may help alleviate pain. Percutaneous nerve blocks not only may be helpful in diagnosing occipital neuralgia, but they can help alleviate pain, as well. Nerve blocks involve either the occipital nerves or in some patients, the C2 and/or C3 ganglion nerves. It is important to keep in mind that the use of steroids in nerve block treatment may cause serious adverse effects.
Surgical Treatment Surgical intervention may be considered when the pain is chronic and severe, and does not respond to conservative treatment.
Microvascular decompression involves microsurgical exposure of the affected nerves, identification of blood vessels that might be compressing the nerves and gentle displacement of these away from the point of compression. "Decompression" may reduce sensitivity, and allow the nerves to recover and return to a normal, pain-free condition. The nerves treated may include the C2 nerve root, ganglion and postganglionic nerve.
Comprehensive Neurosurgical Consultants | Dr. Daniel Rohrer 9155 SW Barnes Road, Suite 210 | Portland, OR 97225 | Phone: 503-546-3503 | Fax: 503-546-3507