What is occipital neuralgia?
Occipital neuralgia is a form of nerve (neuropathic) pain which is caused by injury or irritation to the occipital nerve located in the back of the scalp. The two occipital nerves originate in the second and third vertebrae of the neck.
Occipital neuralgia is often described as a cycle of spasm type pain which starts at the base of the skull and radiates to the back, front and side of the head. Studies have shown that this condition is more common in women.
What causes occipital neuralgia?
Occipital neuralgia usually occurs following an injury to the occipital nerves or sometimes because of irritation to the occipital nerves. Other reasons may be:
- infection or inflammation
- gout
- whiplash injury
- diabetes
- blood vessel inflammation
- arthritis
- tumour
- physical trauma or stress
- spinal cord compression
- repeated contraction of the neck muscles
- frequent and prolonged periods of keeping the head in a downwards and forwards position
Symptoms of occipital neuralgia
People with occipital neuralgia often complain of pain in their nape (back of the neck). The pain is often described as a throbbing migraine type pain or a sharp, shooting pain which spreads upward on the side of the head. It may also spread up over the entire scalp and forehead. They may also feel pain or a pressure behind the eyes and become sensitive to light.
A person suffering from occipital neuralgia may also complain of tenderness in their scalp making such tasks as brushing hair very painful. A chronic headache is commonly accepted as a direct symptom of occipital neuralgia.
Diagnosis of occipital neuralgia
The doctor will take a detailed history and perform a physical examination. There are often tender areas of the scalp over the occipital nerve. A CT or MRI may be carried out to rule out any other abnormality.
Treatment of occipital neuralgia
Medications that can be helpful in the treatment of occipital neuralgia include low-dose tricyclic antidepressants (TCAs). Anticonvulsant medication, originally designed to treat epilepsy, has also been found to be a useful treatment for nerve pain. Side effects include drowsiness and weight gain.
If a person experiences medication related side effects that they are unable to tolerate then an occipital nerve block may be performed. An occipital nerve block is an injection of local anaesthetic and an anti-inflammatory drug around the greater and lesser occipital nerves at the base of the skull.
