Occipital Neuralgia

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Occipital Neuralgia is a pain syndrome resulting from entrapment of the greater or lesser occipital nerve or the third occipital nerve. Pain follows the distributions of C2 and C3, typically with a trigger point near the superior occipital line. Entrapment results from trauma (cervical extension or fracture, suturing through the nerve), atlanto-axial subluxation, and epistrophic (C1-C2) ligament hypertrophy. In the absence of neurologic deficit the condition may be self limited and simply observed. Treatments include peripheral nerve block, C2 nerve root decompression or intradural division, and stabilization (if subluxation or fracture is present).

'Clinical Features'

Patients with occipital neuralgia may describe constant deep or burning pain interspersed with shock-like paroxysms radiating to the vertex. There may also be diminished sensation over the affected area. Relief should follow anesthetic blockage of the involved nerve.

'Treatment'

Correcting an underlying condition such as subluxation or cervical fracture is appropriate when it exists. Since the affected nerve is a purely sensory branch, functional or anatomical destruction are both reasonable options. Nerve injury distal to the root or ganglion may be treated with injections of local anesthetic and steroids. More definitive measures include surgical avulsion of the involved nerve or destruction with alcohol or radiofrequency ablation. More proximal etiologies can be addressed through anesthetic ganglion blockade under fluoroscopy, intradural rhizotomy, or microsurgical ganglionectomy.

'References'

1. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. Cephalalgia 2004; 24:1. 2. Bogduk, N. The anatomy of occipital neuralgia. Clin Exp Neurol 1981; 17:167.

3. Hunter, CR, Mayfield FH: Role of the Upper Cervical Roots in the Production of Pain in the Head. AM J Surg 48:743-51, 1949.