What is occipital neuralgia?

Occipital neuralgia refers to a neuropathic pain caused by damage to the greater occipital nerve, lesser occipital nerve, or other branches of the cervical plexus, which are distributed in the occipital region of the head and the posterior neck.

Which department should be consulted for occipital neuralgia?

English name: occipital neuralgia

Aliases: greater occipital neuralgia, lesser occipital neuralgia, pain in the back of the head

Departments: Neurology, Pain Medicine, Emergency Medicine

What causes occipital neuralgia?

Damage at any point along the pathway of the nerves originating from the cervical spinal cord can lead to neuralgia. Common causes include cervical spine disorders, chronic compression by muscles in the neck and scalp, cervical spinal cord diseases, osteoarthritis, etc. Diabetes, infections, or local skin exposure to cold wind may also trigger occipital neuralgia.

Who is commonly affected by occipital neuralgia?

It can occur at any age but is more common in middle-aged and elderly individuals.

What are the main symptoms of occipital neuralgia?

Occipital neuralgia manifests as sudden pain, often originating in the nape and immediately spreading to the top of the head or mastoid region. The pain is severe, stabbing, sharp, electric shock-like, pulling, or knife-like, lasting for seconds. Between episodes, a persistent dull ache may remain in the occipital area.

The pain may occur spontaneously or be triggered by specific actions (e.g., combing hair, turning the head, exposure to cold environments). Trigger points may also be present.

How is occipital neuralgia diagnosed?

Diagnosis is primarily based on typical clinical features from the patient's history. Physical examination identifying trigger points can support the diagnosis. Temporary pain relief after local anesthetic blockade of the occipital nerve confirms the condition.

Imaging of the cervical and occipital regions is used to rule out cervical spine, spinal cord, or skull base pathologies.

How is occipital neuralgia treated?

Treatment first focuses on addressing the underlying cause. Symptomatic relief is typically achieved through physical therapy (e.g., local heat application to relieve muscle spasms) and medications (e.g., carbamazepine or gabapentin for pain relief, B vitamins for nerve support). If ineffective, local nerve blocks or minimally invasive surgery may be considered.

What complications can occipital neuralgia cause?

Most cases of occipital neuralgia have a good prognosis but may recur. Managing cervical spine disorders, relieving neck muscle tension, and avoiding cold exposure or infections can reduce recurrence. Poor prognosis may occur if the condition is secondary to severe cervical spine, spinal cord, or skull base diseases.