Occipital Neuralgia: Causes, Types, Diagnosis, and Treatment

What Is Occipital Neuralgia?

It is a type of nerve pain (neuropathic pain) involving the occipital nerves, which lie at the back of the head. There are two major occipital nerves on either side of the head, the greater occipital nerve, which gives sensation to the top of the head, and the lesser occipital nerve, which gives sensation in the area around the ear. They are responsible for feeling the pain, light touch, temperature, and vibration on different areas of the scalp. Compression or irritation of these two nerves tends to leave them inflamed and injured. And the affected individual suffers severe piercing 'electric shock' like throbbing pain in the scalp, back of the neck, and around the ears.

What Are the Causes of Occipital Neuralgia?

The occipital nerve may get injured or inflamed due to many reasons. Long-term stress on the nerve and the muscles in the area is one of the reasons. Sitting, standing, or sleeping in the wrong posture also leads to tightening neck muscles and nerve pinching. Occipital neuralgia may be manifested as a symptom of other diseases too. The following are the possible causes of neuralgia:

1. Head or neck trauma, leading to greater or lesser occipital nerve injury.
2. Gout or arthritis of the spine in the neck area.
3. Compression of the nerve due to spinal canal narrowing or disc bulging (intervertebral disc).
4. Tumors involve the occipital nerves' nerve roots as they emerge from the spinal cord.

What Are the Symptoms of Occipital Neuralgia?

Pain is the primary symptom of occipital neuralgia, which the affected individuals often describe as:

• One-sided or two-sided headache that feels like an electric shock, sharp, burning, or stabbing type of pain. It is an agonizing type of nerve pain along with head pounding, tightness in the neck, and shooting pains over the top of the head.
• One may also describe it as migraine-like pain on one side of the head and face. Even the slightest movements, such as brushing the hair, may trigger the pain.
• Tingling, crawling, pins and needles sensation (paresthesia), or decrease in sensation (hypoesthesia) over the scalp
• Skull will be painful to touch. One may also get continuous burning pain in the scalp.

How Is Occipital Neuralgia Diagnosed?

Headache is a symptom common to many disease conditions. Hence, diagnosing occipital neuralgia can be tricky. The doctor will listen to the nature of the pain and other symptoms clearly and do a physical examination to check for pain and spasms in the neck muscles. The following studies help confirm the diagnosis:

1. A neuro exam evaluates the neck's range of motion, how far the individual can rotate or bend it, and checks for abnormal sensations or lack of sensations over the scalp. Additionally, the doctor will check for pain behind the neck below the skull by applying pressure where the occipital nerve comes out of the muscle.
2. An X-ray of the spine in the neck area may show signs of wear and tear.
3. If the patient has severe issues with turning or bending the neck, a magnetic resonance imaging (MRI) scan of the neck (cervical spine) is preferred. One may study the images of the upper parts of the spine because the occipital nerve originates at a very high level of the spinal cord. A high-resolution MRI scan of the neck's upper part may reveal any apparent problems. Such as disc issues, inflammation or fibrous tissue, scar tissue, or anything of that nature because these problems need to be treated first before treating the nerve itself.

What Are the Treatment Strategies for Occipital Neuralgia?

Like any nerve pain, the priority is relieving the pain and other symptoms. The doctor may prescribe anti-inflammatory, muscle relaxant, and anticonvulsant medications to manage the symptoms. Additional treatments are considered if the individual does not improve with medication or gets significant side effects. They are:

• Nerve Blocks- Under the guidance of an ultrasound scanner, the occipital nerves are felt with the fingers. The doctor applies a numbing medication (local anesthetic agent) and injects some local anesthetic and steroid into the area. A nerve block is also used to confirm the diagnosis of occipital neuralgia.
• Pulsed Radiofrequency to the Nerve- Radiofrequency technology is used to locate the nerve and use an electric current to stimulate the nerve. When a greater occipital nerve is stimulated, one may feel a pulsing sensation over the head. On stimulating the lesser occipital nerve, the area over the ear in the scalp will feel a pulsing sensation.
• Ganglionectomy- Is a surgical procedure involving detaching the nerve roots of occipital nerves from the spinal cord to relieve pain and other symptoms. Another method is adjusting the nearby blood vessels by a microvascular decompression procedure so that nerves are freed from the surrounding vessels.
• Prolotherapy- Itis a new type of intervention involving the stimulation of natural healing by injecting dextrose into the painful area and invoking an inflammatory response. It may trigger the natural healing system of the body.
• Botulinum Toxin (Botox) Injections- This effectively reduces the nerve's inflammation.
• Head Movements - Doctors recommend restricting the head movements such as rotating the neck from side to side, bending, and flexing.
• Cold and Heat Compression- Ice packs and cold compression to the affected area may help with muscle spasms. Heat application using a heating pad or heating device may relieve pain at the site of pain. Neck massages are helpful too.

Conclusion:

A wrong posture of the neck and shoulders can often cause occipital neuralgia. Doctors often recommend lifestyle changes, such as adopting the correct sitting posture while working and aligning the body, head, and neck in a straight line using a small pillow under the neck. In addition, one should keep the shoulders slightly shrugged while driving and avoid straps over the shoulders. Pain from occipital neuralgia is often confused with migraine or other headaches. They all seem to have similar symptoms, but the underlying causes and mode of treatment are entirely different, which is why reaching out to a medical expert for an accurate diagnosis matters so much.