symptom .
In general , the pain in occipital neuralgia can be described as continuous or intermittent , severe , sharp , burning or stabbing pain , and usually is localized to a particular nerve distribution . In many cases , these spiking , sharp , and painful attacks are triggered by apparently insignificant stimulation ( such as a simple touch , a whiff of air , cold or hot temperatures ) to the affected area or even by subtle neck or head motion . Some patients may describe specific trigger zones at which stimulation immediately triggers a painful attack – such as rubbing an area of the neck . In most cases , there is no observed neurological damage . Occasionally , patients with occipital neuralgia may show signs of allodynia , which is pain due to a stimulus that does not normally provoke pain ( pressure from clothing or a gentle massage ); or of dysesthesia , which is an unpleasant , abnormal sense of touch .
TYPES OF TREATMENT
Patients with acute occipital neuralgia may benefit from local application of heat or cold . A short course of muscle relaxants and nonsteroidal anti-inflammatory medications ( NSAIDs ) may be of great value . Ultimately , an occipital nerve block , administered by a physician , may be helpful for both diagnostic and therapeutic efforts . In some cases in which the patient is experiencing frequent , severe lancinating , painful spasms – which may be quite disabling – this interventional approach should not be reserved as a last treatment option . Occipital nerve block procedure may be very effective and safe and could be easily and safely performed by a trained physician in a non-hospital setting . This procedure may provide prompt and lasting ( for several weeks or even months ) pain relief or in some cases even abort the disorder completely .
Unfortunately , occipital nerve block frequently provides only temporary pain relief , indicating the need for longterm treatment modalities .
Before initiation of long-term therapy , the health care provider must first assess the patient ’ s behavioral inactivity patterns , emotional background , cognitive factors , sleep pattern , compliance , and existing conditions . Evaluation of these factors should help tailor potential therapy for the individual patient .
Overall , one of the most successful and effective medications in patients with occipital neuralgia is carbamazepine ( Tegretol ®). Treatment usually starts at a dose of 100 mg per day which may be increased by 100 mg increments every 2 to 3 days , to a maximum of 1200 mg . per day , as tolerated . Sedation and dizziness are the most common side effects . Because one of the rare side effects is aplastic anemia , the patient will need frequent monitoring of the carbamazepine serum levels as well as other routine blood tests ( complete blood count and comprehensive metabolic panel ).
If initial therapy with carbamazepine did not produce significant pain relief , other treatment options should be considered . For example , patients with a history of depression and insomnia may benefit from the use of tricyclic antidepressants , such as amitriptyline or nortriptyline . Patients with a history of depression who do not report a significant sleep disturbance but do experience difficulty staying active during the day , may benefit from another tricyclic antidepressant – protriptyline – which typically does not produce sedation .
Patients with coexisting fibromyalgia or diabetes may also benefit from tricyclic antidepressant use . Alternatively , these patients may be considered for treatment with certain membrane stabilizers such as gabapentin and pregabalin . Patients with coexisting migraine may benefit from topiramate and valproic acid
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