Occipital neuralgia is a form of headache caused by inflammation of the occipital nerves, which run up the back of the scalp from where the spinal column meets the neck. Inflammation can result from injury, infection, vasculitis, muscle tension, and a variety of medical conditions, including diabetes and gout. Symptoms include a piercing, throbbing pain located in the back of the head or behind the ears, a tender scalp, and sensitivity to light. Treatment focuses on reducing nerve inflammation, alleviating pain, or severing the nerve.
Diagnosis of occipital neuralgia is essential to rule out other causes of headache and improve the effectiveness of treatment. Doctors may order magnetic resonance imaging (MRI) scans to look for nerve damage, and CAT scans may be performed to check for tumours or other sources of pressure on the cervical spine or nerves. To confirm the diagnosis, a temporary nerve block is injected into the occipital nerves. If symptoms disappear, a diagnosis of occipital neuralgia is given and treatment can begin.
For mild cases of occipital neuralgia, treatment is aimed at reducing pain. Massage and rest are beneficial for many people, and over-the-counter pain relievers may be the only pain medication needed. For more severe symptoms, stronger pain relievers are usually prescribed. Some people respond to over-the-counter anti-inflammatory medications, such as ibuprofen, but prescription-strength pain and anti-inflammatory medications are usually required. Muscle relaxants are helpful when nerve inflammation is due to prolonged sitting or muscle tension. Antiepileptic drugs, such as Neurontin or Tegretol, may also be helpful in reducing symptoms.
Local Nerve Blocks
Local nerve blocks, or occipital nerve blocks, involve the injection of numbing medication directly into the occipital nerve to eliminate pain. Doctors use a thin needle to inject the pain medication, and pain relief is normally experienced within minutes. Depending on the type of procedure and medication used, the area may remain numb for several hours or days. Complications, which are rare, may include infection, bleeding, allergic reactions to the medication, and pain.
Steroid injections may be given along with a local nerve block or used alone. Steroids work by reducing inflammation of the occipital nerves, although it may take several days before symptoms improve. Steroid injections are effective in many cases at controlling pain and inflammation for several weeks or months. In severe cases of occipital neuralgia, the injections may need to be repeated every month.
Surgery is the only permanent treatment option for occipital neuralgia. Surgery is performed to cut the occipital nerve, preventing it from relaying pain signals to the brain. In some cases, the nerve is burnt instead of cut. Surgery may also be performed to decompress the nerve or to fit the patient with an occipital nerve stimulator, which acts like a pacemaker, delivering small electrical charges to the nerve to prevent headaches.