Occipital neuralgia is a condition identified by chronic pain in the upper neck and the back of the head. These areas correspond to the locations of the lesser and greater occipital nerves. Occipital neuralgia most commonly involves the greater occipital nerve, the lesser occipital nerve, and in rare cases, the third occipital nerve. All of these nerves are found in the cervical spine – the neck.
Patients with occipital neuralgia usually complain of severe, lancinating, sharp, short-lasting, spastic, jabbing pain in the occipital area and the neck. They frequently describe the pain as electric shock-like pain that usually lasts from several seconds to 1 to 2 minutes. It usually originates in the occipital area and spreads upward to the top of the head. Although it is usually one-sided, the pain may be felt on both sides. Most patients experience multiple severe attacks during the day. They may or may not experience a dull, low-grade background pain between the painful spasms. Usually, there is increased tenderness in the area of the greater occipital nerve that can be easily
confirmed during physical examination. Palpation of this area may trigger an actual attack or produce paresthesia, which is a sensation of tickling, tingling,
burning, pricking, or numbness of a person’ s skin with no apparent long-term physical effect. This is
often described as“ pins and needles.” The pain syndrome that is characterized by spastic, short-lasting, electric shock-like, painful attacks felt at the back of the head frequently suggests the occurrence of a previous injury or damage to the peripheral nervous tissue or a central nervous system dysfunction. In cases of occipital neuralgia, the occipital nervous tissue damage could be in the form of nerve compression by a tight muscle, degenerative changes in the neck, or sudden nerve injury that may occur during whiplash injury.
Occipital neuralgia is frequently caused by injury or trauma or by the chronic entrapment of the greater or lesser occipital nerve by tight cervical or occipital muscles. Although the“ entrapment theory” seems to be very reasonable and can explain most of the patients’ symptoms, there is a lack of strong clinical evidence to support this theory. This evidence includes multiple surgical studies that were done in the past. The history of recent neck injury can help establish the diagnosis of occipital neuralgia. However, in many cases, the pain occurs spontaneously.
DIAGNOSIS
In establishing the diagnosis of occipital neuralgia, it is very important to differentiate this condition from referred pain in the head and neck area, which could be due to a number of abnormalities affecting the neck muscles, vertebrae, or the shoulder. An initial MRI of the brain and the cervical spine is usually recommended for patients with recent
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