What is occipital neuralgia?
Occipital neuralgia is a type of headache in which the nerves that run from the top of the spinal cord through the scalp (occipital nerves) are inflamed or irritated.
It is characterized by throbbing, piercing, or electric-shock-like chronic pain that starts in the back of your head and moves to the base of your skull. Sometimes, it is referred to as occipital neuritis, suggesting it’s associated with inflammatory changes that affect the occipital nerves.
True isolated primary occipital neuralgia is quite rare. It affects only approximately 3.2/100,000 people per year.
The causes of occipital neuralgia can be either primary or secondary. There are also many cases with an unknown cause.
Individual attacks or episodes of occipital neuralgia may occur spontaneously. It may be triggered by gently touching the occipital nerves, such as brushing the hair, wearing a hat, or lying on a pillow.
Underlying medical conditions
Occipital neuralgia might be caused by irritation or injury of the occipital nerves.
Injury to the back of the head (e.g., whiplash from a car accident) can damage the occipital nerve and lead to occipital neuralgia.
Pinched nerves most commonly cause occipital neuralgia in the root of a person’s neck. Sometimes that is caused by neck muscles that are too tight, causing the occipital nerves to become entrapped. Keeping the head in a forward and downward position for frequent lengthy periods are also associated with occipital neuralgia.
Other causes of occipital neuralgia
Other conditions that can lead to occipital neuralgia include:
- Osteoarthritis of the neck
- Tumors in the neck
- Cervical disc disease
- Blood vessel inflammation (vasculitis)
The primary symptom of occipital neuralgia is sharp, piercing, intermittent, shooting, throbbing, stabbing, severe, electric shock pain. The episodic bursts of intense pain come and go, lasting only for a few seconds or minutes. It may be preceded by tenderness and dull ache around the nerves that persist afterward. Your eyes may also be sensitive to light.
The pain begins at the base of the neck and then spreads upwards to the back of the head, then toward the scalp. For most people, it strikes on only one side of the head and may radiate to behind the eye. Your scalp may be tender to touch, and pain may also be felt when you move your neck. It may be triggered suddenly, even with a simple touch like brushing your hair.
Occipital neuralgia vs. other headaches
The symptoms of occipital neuralgia are oft-confused with migraine and cluster headaches. Some of the overlapping symptoms include sensitivity to light or sound, as well as scalp tenderness.
In particular, significant overlap exists between occipital neuralgia and migraine in terms of severity and tenderness. Like migraines, the pain from occipital neuralgia may affect only one side of the head. However, migraine pain lasts significantly longer than occipital neuralgia.
Nevertheless, occipital neuralgia can be differentiated from other types of headaches based on:
- The cause of the condition.
- The locations where you feel pain.
- The specific symptoms
Underlying causes of occipital neuralgia vs. other headaches
Occipital neuralgia only develops when the occipital nerves are irritated or injured.
Other headaches have more general causes, which can range from sinus infections to high blood pressure to medications and many other potential triggers.
With occipital neuralgia, irritation of the occipital nerves can cause symptoms very similar to that of trigeminal neuralgia, only with symptoms on one side of the scalp rather than in the face.
Cluster headache and hemicrania continua may present occipital tenderness but are also associated with autonomic signs such as eye-watering, eyelid drooping, or eye redness – these features are not typically seen in occipital neuralgia.
Cervicogenic headaches resulting from pain from the nerve roots in the upper neck may have similar symptoms as occipital neuralgia but usually are described as a dull ache as opposed to piercing or stabbing pain.
Tension headaches feel more like a dull throbbing, unlike occipital neuralgia episodes which feel more like stabbing pain.
How is occipital neuralgia diagnosed?
It can be challenging to diagnose occipital neuralgia because it has overlapping characteristics with many other types of headaches. There is no single test to diagnose occipital neuralgia. A thorough evaluation will include medical history, physical examination, and diagnostic tests.
Your doctor will first ask how long you’ve experienced symptoms and may ask questions to identify underlying conditions or injuries. They will also determine the extent to which the symptoms affect your daily living.
If the doctor suspects occipital neuralgia, he will press firmly on the occipital nerves around the back of your neck to see if the pressure elicits a pain response.
To definitively rule out other conditions and to search for the underlying cause of occipital neuralgia, your doctor may order additional imaging tests like a CT scan or an MRI.
A variety of non-surgical therapies may alleviate the pain of occipital neuralgia.
Your doctor may also prescribe muscle relaxers, antiepileptic, and tricyclic antidepressants to lessen the frequency and severity of attacks.
Occipital nerve block
Occipital nerve blocks are a convenient and mildly-invasive pain relief option that your doctor may recommend if conservative measures are ineffective. In this procedure, a local anesthetic or corticosteroid is injected along the affected occipital nerve. Immediate relief can be achieved and may last up to 12 weeks, at which time the injection may be repeated. It may take two to three shots over several weeks to control the pain. Relief with a nerve block in the occipital nerve can also help to confirm the occipital neuralgia diagnosis.
For cases of occipital neuralgia that are difficult to manage, pulsed radiofrequency may confer some benefit. It prevents the occipital nerves from sending pain signals.
If you do not respond well to non-invasive therapy, your doctor may recommend surgical treatment instead. The surgery may decrease pressure on the occipital nerves.
Your doctor may relieve pain by finding and adjusting blood vessels that may be compressing your occipital nerve. The “decompression” may reduce sensitivity and allow the nerves to recover and return to a healthy, pain-free state.
Occipital nerve stimulation
A neurostimulator device is used to deliver electrical pulses to your occipital nerves. It is intended to block the pain messages from reaching the brain.
Occipital release surgery
Occipital release surgery involves making an incision in the back of the neck to decompress the greater occipital nerves. The operation is an outpatient procedure, and you should recover fully within two weeks. However, this procedure is considered a last resort, as it may result in permanent scalp numbness, and pain may also recur.
The Bottom Line
Occipital neuralgia may be a debilitating headache, but it is not life-threatening. There is a wide range of treatment options available to manage your symptoms.