Patients with coexisting migraine may benefit from topiramate and valproic acid derivatives .
derivatives . Application of lidocaine and capsaicin to the skin in the affected area , although not wellstudied , may also be beneficial .
For those patients who fail to respond or are unable to tolerate the above-mentioned treatment modalities , more invasive treatment approaches may be considered , such as occipital nerve decompression surgery and occipital nerve stimulation . Although there is a growing body of evidence that these procedures may be both effective and safe , they should be reserved only for treatment of patients with intractable occipital neuralgia , which does not respond to standard forms of therapy .
Diagnostic Criteria Proposed by The International Headache Society
• Paroxysmal ( spasmodic ) stabbing pain , with or without persistent aching between spasms , in the distribution ( s ) of the greater , lesser and / or third occipital nerves
• Tenderness over the affected nerve
• Pain is eased temporarily by local anesthetic block of the nerve
Case Report
The patient , a 34-year-old male , complained of severe stabbing headaches . He described the pain as burning , electric shock-like pain that originated in the right occipital area and radiated to the top of the head . He states that pain is usually sudden in onset and lasting just a few seconds in duration . He rated the severity of the pain as 9 to 10 on a 1 to 10 scale , with 10 being most severe . The patient may experience between 10 and 20 attacks per day . He states that once the sharp pain is gone , he may still feel a dull , aching pain in the same distribution that may persist for several minutes . The patient also notices that certain neck positions or the application of applying pressure to the right occipital area can also trigger the acute sharp attack . The patient reported that he developed this pain
14 HEAD WISE | Volume 3 , Issue 1 • 2013