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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