What Is Occipital Neuralgia and How Do I Treat It?

What is occipital neuralgia?

What Is Occipital Neuralgia and How Do I Treat It?

 The two larger occipital nerves carry the majority of sensation from the back and top of the head to the brain. On each side of the skull, there is a nerve. The two greater occipital nerves emerge from between the bones of the spine in the upper neck and travel through the muscles of the back of the head to the scalp. They can extend almost to the forehead, but they don't cover the face or the area around the ears; other nerves supply these areas.

A shooting, zapping, electrifying, or tingling pain comparable to trigeminal neuralgia can be caused by irritation of one of these nerves anywhere along its course, with symptoms on one side of the scalp rather than in the face. The pain can sometimes appear to radiate forward (toward one eye) at times. Some patients' scalps become exceedingly sensitive to even the lightest touch, making it practically hard to wash their hair or sleep on a pillow. Numbness in the afflicted area may be present in some people. It's possible that the area where the nerves enter the scalp is highly tender.

What causes occipital neuralgia and how may it be treated?

Occipital neuralgia can develop naturally, as a result of a pinched nerve root in the neck (as a result of arthritis, for example), or as a result of a previous injury or surgery to the scalp or skull. Nerves can be entrapped by "tight" muscles in the back of the skull.

What are the signs and symptoms of occipital neuralgia?

There is no single test that can be used to diagnose occipital neuralgia. Your doctor may use a physical examination to look for soreness in response to pressure along your occipital nerve to determine a diagnosis. An occipital nerve block may be used to identify — and treat temporarily — your condition. The relief provided by a nerve block may aid in the confirmation of the diagnosis. A more permanent surgery may be an useful choice for people who respond well to the temporary "deadening" of the nerve.

What is the prevalence of occipital neuralgia?

Isolated occipital neuralgia is quite uncommon. Many different types of headaches, particularly migraines, can affect the back of the head on one side exclusively or regularly, inflaming the greater occipital nerve on that side and leading to misunderstanding about the diagnosis. These patients are typically diagnosed with migraines involving the larger occipital nerve, rather than occipital neuralgia.

Treatment

Nonsurgical Options for Occipital Neuralgia

Medications and three steroid injections, with or without botulinum toxin, can help to "quiet down" hyperactive nerves. Some patients respond well to non-invasive therapy and do not require surgery; however, some patients do not respond well to non-invasive therapy and may require surgical treatment in the future.

Other treatment possibilities include using a radio-wave probe to burn the nerve or using a modest dose of poison to eliminate the nerve. However, neither of these treatments is always the ideal option because they can permanently deaden the nerve, resulting in scalp numbness.

Surgical Options for Occipital Neuralgia

Occipital release surgery, which involves decompression of the greater occipital nerves along their course, is one surgical alternative.

The surgeon creates an incision in the back of the neck to expose the greater occipital nerves and liberate them from surrounding connective tissue and muscles that may be compressing them during this outpatient operation. Other nerves that may be contributing to the condition, such as the smaller occipital nerves and the dorsal occipital nerves, can be addressed by the surgeon.

The procedure usually takes two to three hours and is carried out with the patient under general anesthesia. Patients are usually allowed to return home the same day, and full recovery takes one to two weeks.

Occipital release surgery may only be effective for a short time before the pain returns. After roughly a year, another surgery to cut the larger occipital nerves can be performed, but this is considered a last resort because it would result in permanent scalp numbness.

--------------------

resource: hopkinsmedicine