What is occipital neuralgia, and what are the causes?
Occipital neuralgia is a rare chronic headache that affects only about three out of every 100,000 people each year. The term “neuralgia” refers to pain in the distribution of a nerve. The occipital nerves run from the top of your spinal cord to your scalp.
Unlike headaches or migraines, occipital neuralgia can be triggered quickly, even with a simple touch like brushing your hair, wearing a hat, or lying on a pillow. The most severe part of an attack is brief, with piercing, throbbing, or electric-shock-like pain lasting only a few seconds to a few minutes. A dull ache may persist between attacks.
The most common cause of occipital neuralgia is pinched nerves in the root of your neck. Sometimes this is the result of tight muscles or a head or neck injury. Chronic neck tension is another common cause.
Typical causes of occipital neuralgia
- Osteoarthritis can compress the nerve as it leaves the spine.
- Tumors or other types of lesions on your neck affect nerve roots.
- Blood vessel inflammation, gout, or infection irritate the nerves.
- Frequent periods of bending the head downward and forward can create tension in the upper neck.
What are the symptoms, and how do they progress?
The primary symptom of occipital neuralgia is sudden, severe pain that you might mistake for a migraine. The episodes of intense pain may only last for a few minutes or seconds, but tenderness around the nerves may persist afterward. Like migraines, the pain may happen more on one side of your head than the other.
Contrary to other headaches, occipital neuralgia episodes feel more like stabbing pain instead of a dull throbbing. You are also unlikely to experience eye watering or redness.
You may experience
- pain in the neck that spreads upwards
- pain in the scalp, forehead, and behind the eyes
- light sensitivity in your eyes and severe tenderness on your scalp
- episodic attacks that last a few seconds to minutes
To diagnose occipital neuralgia, your doctor will discuss your medical history and push on the occipital nerves to temporarily elicit a pain response. You may also receive an occipital nerve block or injection of a local anesthetic that provides temporary relief. Imaging tests such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans can help provide more detail.
What are some home remedy solutions?
Home treatment for occipital neuralgia begins with rest. You will want to try your best to avoid noise or bright lights for a couple of hours. Taking over-the-counter medications and applying a warm compress to the affected area also help with pain management.
Treating occipital neuralgia at NWA Interventional Pain
Treatment for occipital neuralgia is generally symptomatic and includes massage and rest. After a thorough physical examination and medical history, our pain clinic can provide several treatment options that we tailor to your needs.
Because pinched nerves are the primary source of pain, we may start with conservative treatments such as physical therapy and massage to loosen the muscles. We can also prescribe muscle relaxers and pain medicines to help with inflammation and stiffness.
If the pain is isolated to the back of the head without much involvement of the neck, we will likely start with a greater occipital nerve block. You will receive an injection of a corticosteroid and local anesthetic through a small gauge needle. The local anesthetic may start helping the day of the injection, and our goal is to get several months of pain relief. We can repeat injections whenever symptoms flare up.
If there is evidence that neck joint arthritis is the cause of the headaches on the back of the head, then we will have you come in for some test injections to confirm that this is the pain generator. Through the test injections, we will administer a local anesthetic to numb the small nerve that supplies the pain to the cervical facet joint and ask you to fill out a pain diary. Through the tests we try to relieve at least half of your pain before we determine a long-term treatment.
Since there are important structures such as nerves and blood vessels nearby, it’s important to have these procedures performed at a pain treatment center by a Fellowship Trained Interventional Pain Doctor.
What sort of problems can occur after pain treatment?
Injections do not work for everyone, so you should maintain an open dialogue with the pain control clinic about the progress of your treatment. If your symptoms become more severe, you develop a fever of over 101, or you notice redness or drainage at the injection site, you should call your pain doctor or go to the nearest ER.