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​Occipital Neuralgia

Occipital neuralgia is a type of headache. It can be very painful. It sometimes goes along with migraines. Other times, people may confuse it with migraines.

Occipital neuralgia happens when the nerves under your scalp get inflamed.

Certain conditions cause or lead to occipital neuralgia. But often, doctors aren't sure what causes it.

Medicines can help. Some people with occipital neuralgia may get relief from other treatments, including surgery.

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What Is Occipital Neuralgia?

Occipital neuralgia is a distinct headache marked by sudden and recurring jabs of piercing, throbbing pain.

The pain:

  • Comes from the base of the skull in the back of the head.
  • May spread to the top and side of the head behind the ears.
  • Affects one side of the head.
  • Has a trigger point.

Irritated or injured occipital nerves usually cause the pain of occipital neuralgia.

This nerve damage can come from:

  • Trauma such as a car accident.
  • Bone spurs.
  • Surgery in or around the back of the head.
  • An unknown cause.

How common is occipital neuralgia?

Occipital neuralgia is relatively rare. One study found that about 3 per 100,000 people have it.

However, it often overlaps with other illnesses, including migraines.

People with migraines can also have pain in and around their eyes. Arthritis in the neck also can cause a similar pain.

What causes occipital neuralgia?

Doctors don't always know what causes occipital neuralgia.

Most of the time, an inflamed greater occipital nerve causes the pain. The lesser occipital nerve can also cause pain, but this is the case in only about 10% of the cases.

Many things can inflame the nerve, including:

  • Pinched nerves.
  • Muscle tightness.
  • Injury to the head or neck.
  • Arthritis of the bones in the upper back and neck.
  • Tumors in the neck.
  • Surgery in the back of the head.
  • Long periods with the head looking down and forward.

Occipital neuralgia risk factors

Some conditions can increase your risk of having occipital neuralgia, such as:

  • Diabetes.
  • Gout.
  • Inflamed blood vessels.
  • Degenerative cervical spine changes.

Researchers are still trying to learn more about what increases someone's risk for these types of headaches.

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What Are the Symptoms of Occipital Neuralgia?

Some people have occipital neuralgia pain that is similar to migraines.

People may first go to the doctor for migraine pain. During their exam and testing, they learn they also have occipital neuralgia.

Unlike migraines, occipital neuralgia can last just seconds or minutes. It's often sharp and quick. It can also last much longer and turn into migraine-like pain.

Sometimes a movement as basic as brushing your hair can trigger it.

Pain that doesn't include light sensitivity or nausea is more likely occipital pain than migraine pain.

Occipital neuralgia symptoms may include:

  • Piercing, shooting head and neck pain that radiates from the base of the skull.
  • Constant burning pain.
  • Tender scalp, often with pain on one side.
  • Extreme sensitivity to light.
  • Pain behind the eyes.
  • Numbness and tingling in the neck and face.

When to should I see a doctor for headache symptoms?

Make an appointment to see a doctor if you have:

  • Sharp, intense scalp or neck pain that is different from other headaches.
  • Pain that at first seems like a migraine but doesn't have light sensitivity or nausea.
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How Do Doctors Diagnose Occipital Neuralgia?

Occipital neuralgia is hard to diagnose. It shares symptoms with migraines and other types of headaches.

There's no single test that offers a solid diagnosis.

Rather, after a physical and neurological exam, doctors may order tests such as:

  • MRI scans to get a 3D view of the vessels and nerves inside the head and neck.
  • CT scans to get cross-sectional images of bone in the upper spine and skull, blood vessels, and other structures.
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How Do Doctors Treat Occipital Neuralgia?

Doctors will often treat occipital neuralgia without surgery.

The goals of treatment are to help you manage symptoms and to get rid of the pain.

There's no single cure or treatment that works for everyone.

Doctors often start with conservative treatments and then progress to more invasive therapies. Keeping an open dialog with your doctor about your symptoms is vital.

Pain management

Doctors typically manage occipital neuralgia without surgery.

Many people can improve the illness with techniques to manage pain, including:

  • Physical therapy to help strengthen the muscles around the neck.
  • Massage therapy to relax the muscles and nerves.
  • Medicines including anti-inflammatory drugs, muscle relaxants, antidepressants, and anticonvulsant medicine.
  • Pain-relieving shots, called percutaneous nerve blocks, that target the nerve causing the pain.

If these treatments don't work, we can treat occipital neuralgia with surgery.

Surgery to treat occipital neuralgia

Surgery is a last resort for people who have painful symptoms after trying all other treatments.

Surgery depends on the person and may include:

  • Occipital release surgery detaches the occipital nerves from tissues constraining or compressing them.
  • Occipital nerve stimulation uses electrodes to block pain signals with electric pulses.
  • Occipital rhizotomy cuts the nerve where it exits the spine.

UPMC neurosurgeons may recommend a mix of surgical and nonsurgical approaches to treat occipital neuralgia.

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