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Occipital Neuralgia

Occipital neuralgia is a type of neuralgia that may result from a whiplash injury or some injury to the back of the head.

This type of headache is a very distict one with true neuralgia sypmtoms of stabbing electric shock type pain. If milder, the pain is throbbing and can radiate down the neck and up over the top of the head. Some patients will complain of pain behind the ear.

This pain is coming from the greater occipital and lesser occipital nerve which originate at the point where the skull meets the neck at the back of your head.

The pain can result from some sort of injury to the nerve due to:

  • Spasm of muscles around the nerves
  • Compression of the nerves due to whiplash
  • Infection, usually viral
  • Tumor, compressing the nerve
  • Diabetes
  • Unknown

If the pain in the back of the head is accompanied by neck pain then occipital neuralgia headaches are actually a form of cervicogenic headache.

Diagnostic Studies

Most of the time, this is a fairly straightforward diagnosis. When you are examined, the examiner may tap the back of your head lightly and if this causes pain then the nerve is inflammed a bit. Some providers will order X-rays, a CT or MRI of the cervical spine to rule out any pathology. This is especially appropriate if the pain is the result of a motor vehicle accident with whiplash, or a fall where the back of the head has been struck.

Treatment Of Occipital Neuralgia

Many times a short course of steroid or low dose anti-depressant will calm the nerve down and relieve the pain. Failing that an occipital nerve block can be done by your doctor.

Occipital nerve blocks are simple injections of steroid mixed with a numbing agent (like lidocaine) into the area around the nerves. This serves to stop the pain signals going to the brain. 85-90% of people will respond to occipital nerve blocks.

If the pain returns, the blocks can be repeated in about a month. This is also very effective for chronic migraine. I have a few patients who come in once a month and get blocks done on both sides, which helps reduce their headache frequency.

At times, this pain sends signals to the brainstem through the C2C3 area and can trigger a migraine.

occipital nerve block

Read more about different types of headaches if occiptal headache doesn't sound like you.

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