Occipital neuralgia is a persistent pain that is caused by an injury or irritation of the occipital nerves located in the back of the head.
The greater and lesser occipital nerves run from the region where the spinal column meets the neck (the sub-occipital region) up to the scalp at the back of the head. Trauma to these nerves can cause a pain that originates from the lower area of the neck between the shoulder blades.
Although statistics indicating the frequency of persons with occipital neuralgia are unknown, the condition is more frequent in females than males.
Causes and symptoms
Occipital neuralgia is caused by an injury to the greater or lesser occipital nerves, or some irritation of one or both of these nerves. The repeated contraction of the neck muscles is a potential cause. Spinal column compression, localized infection or inflammation, gout, diabetes, blood vessel inflammation, and frequent, lengthy periods of maintaining the head in a downward and forward position have also been associated with occipital neuralgia. Less frequently, the growth of a tumor can be a cause, as the tumor puts pressure on the occipital nerves.
The result of the nerve damage or irritation is pain, which is typically described as continuously aching or throbbing. Some people also have periodic jabs of pain in addition to the more constant discomfort. The level of pain can be intense, and similar to a migraine. This intense pain can cause nausea and vomiting.
The pain typically begins in the lower area of the neck and spreads upward in a "ram's horn" pattern on the side of the head. Ultimately, the entire scalp and forehead can be painful. The scalp is also often tender to the touch. Additionally, persons with occipital neuralgia may have difficulty rotating or flexing the neck, and pain may radiate to the shoulder. Pressure or pain may be felt behind the eyes, and eyes are sensitive to light, especially when headache is present.
Diagnosis is based on the symptoms, and especially on the location of the pain. Medical history is also useful. A history of muscle tension headaches over a long period of time is a good indicator that the current pain could be a neuralgic condition such as occipital neuralgia. While many people experience a tension headache due to the contraction of neck and facial muscles, few people experience the true neuralgic pain of occipital neuralgia. Nevertheless, physical and emotional tension can be contributing factors to the condition.
The treatment team typically is made up of someone capable of giving a massage, and a family physician. A neurologist and pain specialist may also be consulted. In the rare cases that surgery is required, a neurosurgeon is also involved.
Treatment usually consists attempting to relieve the pain. This often involves a massage to relax the muscles in the area of the occipital nerves. Bed rest may relieve acute pain. In cases in which the nerve pain is suspected of being caused by a tumor, a more specialized examination is done using the techniques of nuclear imaging or computed tomography (CT ). These techniques provide an image that can reveal a tumor. If present, the tumor can be removed surgically, which usually cures the condition.
In cases in which the pain is especially intense, as in a migraine type of pain, pain-relieving drugs and antidepressants can be taken. Other treatments involve the blocking of the impulses from the affected nerve by injection of compounds that block the functioning of the nerve. Steroids can also be injected at the site of the nerve to try to relieve inflammation. However, the usefulness and long-term effects of this form of steroid therapy are not clear.
In extreme cases where pain is frequent, the nerves can be severed at the point where they join the scalp. The person is pain-free, but sensation is permanently lost in the affected region of the head.
Recovery and rehabilitation
Recovery is usually complete after the bout of pain has subsided and the nerve damage has been repaired or lessened.
As of April 2004, there were no clinical trials in the United States that are directly concerned with occipital neuralgia. However, research is being funded through agencies such as the National Institute of Neurological Disorders and Stroke to try to find new treatments for pain and nerve damage, and to uncover the biological processes that result in pain.
The periodic nature of mild occipital neuralgia usually does not interfere with daily life. The prognosis for persons with more severe occipital neuralgia is also good, as the pain is usually lessened or eliminated by treatment.
Loeser, J. D. "Occipital Neuralgia." Facial Neuralgia Resources. April 14, 2004 (June 2, 2004). <http://www.facial-neuralgia.org/conditions/occipital.html>. "
NINDS Occipital Neuralgia Information Page." National Institute of Neurological Disorders and Stroke. April 12, 2004 (June 2, 2004). <http://www.ninds.nih.gov/health_and_medical/disorders/occipitalneuralgia.htm>.
National Institute for Neurological Diseases and Stroke (NINDS). 6001 Executive Boulevard, Bethesda, MD 20892. (301) 496-5751 or (800) 352-9424. <http://www.ninds.nih.gov>.
National Organization for Rare Disorders. 55 Kenosia Avenue, Danbury, CT 06813-1968. (203) 744-0100 or (800) 999-6673; Fax: (203) 798-2291. [email protected] <http://www.rarediseases.org>.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). 31 Center Dr., Rm. 4C02 MSC 2350, Bethesda, MD 20892-2350. (301) 496-8190 or (877) 226-4267. [email protected] <http://www.niams.nih.gov>.
Brian Douglas Hoyle, PhD