Occipital Neuralgia

Description

Occipital neuralgia describes a headache that characteristically occurs in the back of the head and upper neck. The pain occurs in the distribution of the occipital nerves, which are sensory nerves innervating the upper neck and the back of the head.

Causes

  • Diabetes

  • Infections

  • Gout

  • Cervical disk disease

  • Arthritis

  • Muscle spasms or tension

  • Trauma to the back of the head

  • Vasculitis, or inflammation of the blood vessels

Symptoms

  • Sensitivity to light

  • One-sided scalp pain

  • Burning pain that is often constant

  • Sharp pain that radiates from the base of the skull to the head and neck

Diagnosis

Tenderness to pressure is noted along the course of the occipital nerve along with muscle spams in the neck region. A nerve block performed by an interventional pain management physician can help confirm the diagnosis if it alleviates the pain. Diagnostic imaging can be ordered if the physician suspects some underlying cause such as a tumor.

Management

Conservative treatment such as the application of warm compresses and over the counter pain medications are the first line of treatment.

If symptoms persist, physical therapy can be beneficial along with prescription medications such as muscle relaxants, antiepileptics and tricyclic antidepressants.

If symptoms do not improve significantly, additional nerve blocks can be performed.

In rare circumstances, nerve decompression surgery may be necessary.