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