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Occipital Neuralgia: Causes, Types, Diagnosis, and Treatment

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Occipital neuralgia is a painful condition of the scalp and neck when the occipital nerves are injured or inflamed as they emerge from the spinal cord.

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Prakashkumar P Bhatt

Published At November 7, 2022
Reviewed AtNovember 11, 2022

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.

Frequently Asked Questions

1.

What Can Flare up Occipital Neuralgia?

Occipital neuralgia can flare up if the sleeping position is wrong and when there is inadequate sleep. Sleeping in a poor posture is sometimes the sole reason for developing occipital neuralgia in some individuals. Even slight movements like brushing the hair may trigger the pain. 

2.

How Does Occipital Neuralgia Feel?

A one-sided or two-sided headache can feel like an electric shock, and the affected individuals describe a sharp stabbing pain. It can be agonizing and cause head pounding, neck tightness, and shooting pain on the top of the head. In addition, migraine-like headaches, tingling, crawling, and pins and needle sensation can be felt on the scalp. 

3.

Which Is the Most Common Cause of Occipital Neuralgia?

Long-term stress on the neck muscles and nerves is another reason for occipital neuralgia. Sitting, standing, or sleeping in the wrong posture also tightens neck muscles and causes nerve pinching. Other possible causes are head and neck trauma, gout or arthritis of the spine, compression of the nerve, and tumors involving the occipital nerve. 

4.

Is Occipital Neuralgia Treatable?

Treating the pain is the priority in managing occipital neuralgia. The physician prescribes drugs, including anti-inflammatories, muscle relaxants, and anticonvulsants. Additional treatment modalities include,
- Nerve blocks.
- Pulsed radiofrequency to the nerve.
- Ganglionectomy.
- Prolotherapy.
- Botox injections.
- Cold and heat compression.

5.

How Fast Can One Recover From Occipital Neuralgia?

Occipital neuralgia can last from a few hours to several days. Symptoms are managed with painkillers, muscle relaxants, and heat and cold application. Stretching and massage also help relieve pain caused by occipital neuralgia. An occipital nerve block has been proven to provide symptomatic relief within two weeks. 

6.

Is Occipital Neuralgia Detectable on an MRI?

The images of the upper parts of the spine can be studied in an MRI because the occipital nerve originates at a very high level of the spinal cord. Therefore, a high-resolution MRI scan of the upper part of the neck can reveal any apparent problems that cause occipital neuralgia. 

7.

Where to Massage for Relieving Occipital Neuralgia?

Neck massages help manage occipital neuralgia. Applying gentle pressure to the base of the skull can help calm the tight muscles and release the tension, thereby providing relief. Applying pressure with a towel can provide a gentle massage. 

8.

Which Medication Best Helps Occipital Neuralgia?

Anti-neuropathic medications such as Pregabalin and Gabapentin will help dampen the overactivity of damaged nerves. Hence such medications are considered best to treat occipital neuralgia. For pain management, painkillers, muscle relaxants, and anticonvulsants are prescribed.

9.

What Foods Should Be Avoided in Occipital Neuralgia?

In some patients, excessive sugar consumption can trigger headaches. So, sugar consumption and consuming processed foods should be reduced. Eating fresh foods and staying hydrated throughout the day can help prevent pain caused due to occipital neuralgia.

10.

Does Using a Pillow Help in Managing Occipital Neuralgia?

Using pillows that can support the neck and not allow the head to be higher than the neck can help ease the pain. Do not place the neck in a crooked position, as this can cause stiffening and contraction of the head and neck muscles. 

11.

Do Chiropractors Treat Occipital Neuralgia?

Chiropractors can help reduce pain through multiple cervical spine manipulations. In addition, spinal manipulation can help reduce tension and pain in this area. Chiropractic care does not have many side effects. Therefore, chiropractic care is highly efficacious.

12.

Can Lying Down Make Occipital Neuralgia Worse?

No proper sleeping position can help or make the occipital neuralgia worse. However, sleeping on the back with the head elevated using the support of a cervical pillow can help ease the pain. 
Dr. Prakashkumar P Bhatt
Dr. Prakashkumar P Bhatt

Neurology

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occipital neuralgia
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