What Is Occipital Neuralgia?

Occipital neuralgia refers to an inflammation of the occipital nerves found in the back of the head and neck. There are three pairs of occipital nerves that commonly suffer from inflammation:

  • The two Greater Occipital Nerves (GON) are found on each side of the upper neck at the base of the back of the scalp
  • The Third Occipital Nerves (TON) are found a few centimeters below the GON
  • The Lesser Occipital Nerves (LON) are found on each side of the neck a few centimeters below the back of the ear

Occipital neuralgia most often produces a pain that feels like a tight, electric shock and many patients with severe occipital neuralgia report some type of headache. Chronic migraine, status migrainosus, chronic headache and tension headaches are all diagnoses that may be given to patients with occipital neuralgia.

occipital neuralgia

What Is Neuralgia and What Are the symptoms?

The term neuralgia refers to inflammation affecting one or more nerves anywhere in the body. The causes of neuralgia vary from viral infection to trauma causing an inflammatory response, just like any part of the body would react to a traumatic event.

Acute neuralgia is limited by time and usually has a specific cause that, when treated, allows the nerve to return to its normal state. Chronic neuralgia is long-term inflammation of the nerve, which often comes from a repeated or ongoing injury.

Occipital neuralgia patients typically complain of headache pain and other symptoms including: Paresthesias, or strange sensations in the head and neck region that are often accompanied by pain in the extremities and face, nausea and vomiting, dizziness and tinnitus, or ringing in the ears, which can occur with or without pain.

The Diagnosis and Misdiagnosis of Occipital Neuralgia

To properly diagnose occipital neuralgia, a diagnostic nerve block is performed with local anesthesia such as Lidocaine. The local anesthesia quickly deactivates the injected nerve, though only for a short time. After a few minutes, a patient with occipital neuralgia who has had this diagnostic nerve block will feel a significant improvement in their pain. This short-term pain relief following a nerve block indicates occipital neuralgia is the underlying issue. This response is also an indication that such a patient is an excellent candidate for nerve decompression surgery to provide long term pain relief.


How is trauma related to occipital neuralgia?

Traumatic injury of the head and neck is often a factor in the onset of occipital neuralgia, though occipital neuralgia can be an issue in the absence of trauma as well. The whiplash injury of a car accident, for example, is a trauma that can cause chronic inflammation of the occipital nerves.

How Is Occipital Neuralgia Treated?

The pain and symptoms of occipital neuralgia are usually first treated with medications. Drugs that work primarily on nerves themselves, such as Neurontin, may be utilized. Some patients do respond to migraine medications, such as drugs in the triptan family, and the use of these medications is “abortive.” An abortive drug is taken once the pain begins in order to stop the pain from getting worse.

Beta-blockers, antidepressants and other medication may be used in occipital neuralgia patients to try to prevent pain from occurring in the first place. These drugs sometimes have a beneficial effect for migraine sufferers, and the two diagnoses are often confused.

Botox may be used to treat migraine headaches for patients who have a muscular component to their nerve compression, however occipital neuralgia patients with nerve irritation from connective tissue or blood vessels crossing the nerves will have no response to Botox. Some patients experience improvement of their occipital neuralgia symptoms with an injection of steroids around the nerves.

Some patients may have nerve stimulators placed around the nerve to create overstimulation of the affected nerve. This overstimulation can prevent the nerve from transferring pain sensation and can effectively reduce occipital neuralgia pain. Nerve stimulators are often avoided by patients because of their complication rate and their limited life span.

The Surgical Treatment of Occipital Neuralgia

Microvascular decompression of the occipital nerves is frequently called “migraine surgery.” Once the problematic nerve is found, connective tissue or scar tissue causing compression or kinking of the nerve is removed, and a channel is created in the surrounding muscle so the nerve can travel freely.

Surgical treatment for occipital neuralgia is usually an outpatient procedure that takes about three hours. After a few weeks, patients are usually back to their regular routine. The results of surgery for occipital neuralgia should be permanent.

Occipital Neuralgia Is Often Treatable

In recent studies, nearly 90% of patients experience long-term improvement if not complete alleviation of their pain following occipital nerve surgery. Patients who see Dr. Lowenstein for nerve decompression surgery have often seen many doctors and tried and failed many other attempts at a cure. It is essential for head and neck pain patients to be their own advocates, as the diagnosis of occipital neuralgia may be overlooked or delayed after ongoing pain.

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