Occipital neuralgia is a particular kind of headache. Its characteristics include pain in the upper neck, the back of the head, behind the ears and usually on one side of the head. The scalp might be tender to the touch; there may be pain behind the eyes and forehead; and the headaches may cause light sensitivity. The pain is piercing, throbbing, or like electrical shocks. The symptoms usually start in the neck and move up into the head and scalp. Treatment consists of controlling or alleviating the pain.
The chief preventive measure in the treatment of occipital neuralgia is antidepressant therapy. The use of antidepressants is a main treatment in the prevention of several types of headaches, including occipital neuralgia, according to the neurology information clearinghouse Sarasota Neurology. The use of antidepressants in this way has no relationship to depression.
Headaches caused by occipital neuralgia do not respond to the same therapies as some other headaches, such as migraines or sinus headaches. There are non-surgical, conservative treatments that have been shown to be effective in diminishing occipital neuralgia pain or alleviating it altogether. These include the application of heat, physical therapy, massage, rest, anti-inflammatory medications, muscle relaxants and anticonvulsant medications. In cases of extreme pain, antidepressants have shown some efficacy, as well.
Another non-surgical treatment involves percutaneous nerve blocks applied to either the occipital nerves or the C2 and/or C3 ganglion nerves. The nerve blocks not only help relieve pain symptoms, but are also useful in diagnosing conditions causing the pain. If the blocks are done with steroids repeatedly, considerable risks can be involved. The patient and doctor should discuss these in detail.
When non-surgical treatment is not effective and the pain of occipital neuralgia is chronic, one of two types of surgery might be an option. The patient and attending physicians should weigh the risks and benefits of the surgery to see if such a procedure is in the patient's best interest.
Microvascular decompression surgery exposes the occipital nerves and the vessels around them. The vessels are moved away from the nerves, and this may result in less pressure on the nerves so they can function more normally, rather than sending pain signals to the patient's brain.
Occipital nerve stimulation is another surgical procedure to treat occipital neuralgia. The pain from the headaches occurs in the areas near the path of the occipital nerves. Insulated wires attached to a neurostimulator are inserted under the skin. The wires send electrical pulses that can block the pain messages from being sent to the brain. This procedure is less invasive than decompression and does not damage the nerves or the areas around them.