How Do You Treat Occipital Neuralgia?

Occipital neuralgia, or nerve pain in the head that can cause severe headaches and other symptoms, may require surgery in severe cases. Milder cases respond to heating pads and home treatments or injected nerve-blocking medications.

Occipital neuralgia is a type of nerve pain in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed. 

What Are Symptoms of Occipital Neuralgia?

Symptoms of occipital neuralgia include: 

• Continuous headaches 
  • Feels like severe piercing, throbbing, aching, or burning 
  • Shock-like or shooting pain 
  • Usually starts in the upper neck and travels to the back of the head, the scalp on one or both sides of the head, or behind the ears
• Pain behind the eye of the affected side of the head
• Light movements such as brushing hair may trigger pain
• Pain 
  • Often described as migraine-like 
  • May have symptoms common to migraines and cluster headaches

Primary occipital neuralgia is often caused by: 

• Pinched nerves in the neck
  • Compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes
• Chronic muscle tightness in the neck
• Head or neck injury
  • Trauma to the greater and/or lesser occipital nerves
• Osteoarthritis of the upper cervical spine
• Cervical disc disease
• Tumors affecting the C2 and C3 nerve roots
• Gout
• Diabetes
• Blood vessel inflammation
• Infection

Secondary occipital neuralgia is associated with an underlying disease.

Diagnosing occipital neuralgia can be complicated since there is no definitive test used to make a diagnosis. Occipital neuralgia is usually diagnosed with a patient history and physical examination, as well as: 

• Neurological exam
• Magnetic resonance imaging (MRI) test 
• Computed tomography (CT) scan 
• Occipital nerve blocks 

The goal of treatment for occipital neuralgia is to relieve the pain, but it does not cure the condition. 

Non-surgical treatments for occipital neuralgia include:

• Heating pads
• Physical therapy or massage therapy
• Medications
  • Anti-inflammatory medications
  • Muscle relaxants
  • Anticonvulsants
• Percutaneous nerve blocks
  • Injections used both to diagnose and treat occipital neuralgia
  • Botulinum toxin (Botox) injections to decrease nerve inflammation 

Surgical treatments for occipital neuralgia include:

• Occipital nerve stimulation
  • A minimally invasive procedure that does not damage surrounding nerves and structures
  • Electrodes are placed under the skin near the occipital nerves
  • This treatment works the same way as spinal cord stimulation and uses the same device
  • An off-label use for an FDA-approved device
• Spinal cord stimulation
  • Stimulating electrodes are placed between the spinal cord and the vertebrae
  • Electrical impulses are produced to block pain messages from the spinal cord to the brain
• C 2-3 Ganglionectomy
  • Disrupts the second and third cervical sensory dorsal root ganglion.