What is Occipital Neuralgia?
Occipital neuralgia is a painful disorder that occurs when the occipital nerves that travel from the top of your spine to your scalp are irritated or compressed, causing significant pain at the base of the skull or at the back of the head. It is a rare type of chronic headache condition and is estimated to affect around three out of every thousand individuals every year.
Signs and Symptoms of Occipital Neuralgia
Occipital neuralgia is characterized by throbbing, piercing, or electric-shock-like constant pain in the back of the head, upper neck, and behind the ears, typically on one side of the head. Usually, the pain starts at the neck region and gradually spreads upwards. Some people will also feel pain behind the eyes, forehead, and scalp. Their scalp may also be tender to touch, and their eyes particularly sensitive to light.
Causes of Occipital Neuralgia
Occipital neuralgia is most often caused by pinched or compressed nerves in the root of an individual’s neck. Sometimes, the condition is caused by muscle tightness in an individual’s neck. In some instances, it can also be caused by a neck or head trauma. Persistent tension in the neck is another common source of occipital neuralgia.
Some of the other medical conditions that can result in or contribute to occipital neuralgia include:
- Bone spurs or osteoarthritis in the upper cervical spine region, which can pinch nerves
- Inflammation of the blood vessel in the neck region
- Gout affecting the cervical spine
- Tumors affecting nerve roots
Diagnosis of Occipital Neuralgia
In order to diagnose occipital neuralgia, your physician will perform a thorough physical examination and review your symptoms and medical history. Your physician may order blood tests to check for infection, along with MRI and ultrasound for a detailed evaluation of structures surrounding the neck and head. Spinal tap (examination of cerebrospinal fluid that bathes the brain and spinal cord) or electromyography (measures nerve conduction) may also be ordered for further analysis. A dental examination may be required to rule out other causes of facial pain.
Treatment for Occipital Neuralgia
The treatment of occipital neuralgia focuses on treating the underlying causes. Your doctor may prescribe analgesics, as well as antiseizure, antidepressant, and anticonvulsant medications for pain. A nerve block injection (reduces inflammation and turns off pain signals) may be administered in cases of severe pain. Physical exercise might help you in alleviating pain and increasing neck movement. You will be advised to keep your blood sugar levels under control if you are diabetic.
If conservative treatment does not produce desired results, your physician may recommend minimally invasive surgeries such as occipital nerve stimulation and spinal cord stimulation. During occipital nerve stimulation, your surgeon places a device at the base of the skull where the occipital nerve originates. The device sends electrical signals to target one or more of the occipital nerves transmitting the pain. The spinal cord stimulation procedure involves placement of stimulating electrodes between the vertebrae and spinal cord. The device generates electrical impulses to obstruct pain signals from the spinal cord to the brain.
Rarely, surgery might be required to relieve the pressure of impeding structures such as blood vessels, tumors, bones, and ligaments of the nerves.