While not an actual headache itself, occipital neuralgia represents irritation or inflammation of the occipital nerves which under normal circumstances provide sensation to the back of the head. This inflammation can cause abnormal signaling to the brain resulting is severe headaches or pain it the neck itself. Occipital neuralgia can often be improved by releasing the constriction of the tissue surrounding the occipital nerves, providing lasting relief from ongoing pain.

FAQs: Occipital Neuralgia

  • What is occipital neuralgia?

    Occipital neuralgia is an inflammation of the occipital nerves. There are three principal occipital nerves in the back of the neck and head- the greater occipital nerve (GON), the lessor occipital nerve (LON), and the third occipital nerve (TON). The inflammation of occipital neuralgia may involve any or all of these nerves.
  • What causes inflammation of the occipital nerves in occipital neuralgia?

    Inflammation can be caused by many different things, but in most cases it is compression of one form or another that causes inflammation in occipital neuralgia. While a local mass or tumor is a rare reason for this compression, most occipital neuralgia is caused by compression by muscles, small bands of fascia (connective tissue), or often blood vessels. The sensation of pulsating pain that many occipital neuralgia patients experience is often a manifestation of a pulsating artery that is pushing on one of the occipital nerves and causing pulsating pain.
  • What are symptoms of occipital neuralgia?

    Occipital neuralgia patients most often complain of pain which can be quite severe and debilitating, but a great many symptoms may accompany headaches in occipital neuralgia. Paresthesias, or strange sensations in the head and neck region are often experienced and can be accompanied by pain in the extremities and face. Nausea, vomiting, and dizziness are frequent symptoms of occipital neuralgia. Tinnitus or ringing in the ears can occur with or without pain, as the other symptoms can similarly come and go in an irregular fashion.
  • How is trauma related to occipital neuralgia?

    Traumatic injury of the head and neck is in many instances the instigating factor in the onset of occipital neuralgia. The whiplash injury of a car accident is a classic manner in which trauma can cause chronic inflammation of the occipital nerves. The sudden stretch of the nerve may cause direct inflammatory damage to any of the occipital nerves, but adjacent injury to muscle and connective tissue can cause swelling and compression of adjacent structures- including the nearby occipital nerves. Other issues, such as injury to the spine or nerve roots can also come from these types of injuries and must be evaluated when post-traumatic pain is experienced in the head and neck.
  • How is occipital neuralgia diagnosed?

    Occipital neuralgia is often a diagnosis of exclusion, meaning that when other causes of pain are ruled out, occipital neuralgia is then sometimes felt to be the cause. In fact, a very good diagnostic test for occipital neuralgia involves nerve blocks to the affected nerves. In most cases, a local anesthesia is injected at one of the nerves on either or both sides of the neck, and following a few minutes the patient’s pain is re-assessed. If the pain is improved but not gone, a second nerve is blocked. The third nerve can then be blocked if further improvement is sought. Successful reduction in pain by a nerve block is diagnostic for occipital neuralgia and also an indication that surgical decompression or disruption of the occipital nerves is likely to provide improvement or complete elimination of the patient’s symptoms.
  • How is occipital neuralgia treated?

    The pain and symptoms of occipital neuralgia are usually first treated with medications. Similar to the treatment of migraine headaches, drugs such as serotonin inhibitors, anti-convulsants, and anti-depressents are often used to try to control occipital neuralgia. Since non-narcotic pain medications such as Tylenol, aspirin and Motrin are often not successful, patients are sometimes started on narcotics to try to deal with occipital neuralgia pain. The difficulty with narcotic addiction and the need for increasing doses to achieve pain relief are extremely problematic and can lead to secondary and life threatening issues.If muscle constriction is primarily implicated in occipital neuralgia, the injection of Botox may allow for localized weakness of the tight muscles and can be helpful in providing medium range relief for occipital neuralgia pain. Botox mediated relief can be expected to last one to three months before needing to be repeated. Similarly, some patients experience improvement of their occipital neuralgia symptoms with injection of steroids around the nerves. Since steroids are known to decrease inflammation, it is felt that this type of injection lessens the inflammation at and around the nerves leading to improvement. Some patients may have nerve stimulators placed around the nerve to try to create an over-stimulation of the effected nerve. This overstimulation actually can prevent the nerve from transferring pain sensation and can be an effective way to reduce occipital neuralgia pain. Unfortunately these nerve stimulators are often placed by non-surgeons who may not be routinely locating the nerves. Because of the variability of the anatomy of the occipital nerves, such stimulators are often placed distant from the effected nerve and thus result in an unsuccessful outcome.
  • When and how is surgery effective for the treatment of occipital neuralgia?

    Surgery for occipital neuralgia is most often left as the last option for occipital neuralgia patients. When less invasive treatments are successful, the surgical option is not felt to be needed. For many patients who still have pain and other occipital neuralgia symptoms despite less invasive treatments, Dr. Lowenstein’s surgery for occipital neuralgia can provide lasting and often permanent improvement or relief. The surgical plan is dictated by pre-operative nerve blocks which show which nerves need to be manipulated. While sometimes only one or two nerves on one side of the neck need to be addressed, sometimes all three nerves on both sides are operated upon. The surgery is performed under general anesthetic in the prone, or face down position, and one to three incisions are used to gain access to the affected nerves. Depending on the condition of the nerves when they are identified, the nerves may be released of their surrounding compression, or they may be divided to prevent their further conduction of painful signals. Surgery for occipital neuralgia often takes one to three hours depending on the number and condition of the nerves to be addressed.
  • What are the expectations following surgery at Dr. Lowenstein’s Headache Center?

    Because surgery involves manipulation of the nerves themselves as well as the surrounding structures, patients may experience anything from immediate relief to temporary worsening of their symptoms. Variability in the improvement of the occipital neuralgia symptoms are not unusual for the first months following occipital neuralgia surgery, but in recent studies nearly 90% of patients experience long term improvement if not complete alleviation of their pain following occipital nerve surgery.

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