Occipital neuralgia is a rare type of chronic headache disorder. It occurs when pain stems from the occipital region and spreads through the occipital nerves. The occipital nerves run from the top of your spinal cord to your scalp.
Unlike headaches or migraines, occipital neuralgia can be triggered quickly, even with a simple touch like brushing your hair. The most severe part of the attacks is brief, with intense, sharp pain lasting only a few seconds to a few minutes. Migraine pain, which is also severe, lasts much longer than pain from occipital neuralgia.
It’s estimated that occipital neuralgia affects about three out of every 100,000 people every year.
What are the symptoms of occipital neuralgia?
The primary symptom of occipital neuralgia is sudden, severe pain that many people associate with migraines. This pain is described as intense, piercing, stabbing, and sharp. The episodes of intense pain may only last for a few minutes or seconds, but tenderness around the nerves may persist afterward. Like migraines, the pain may happen more on one side of your head than the other.
Occipital neuralgia episodes are unlikely to have symptoms like eye watering or eye redness, which is common with other primary headache disorders. Unlike tension headaches, occipital neuralgia episodes feel more like stabbing pain instead of a dull throbbing.
What causes occipital neuralgia?
Occipital neuralgia is most commonly caused by pinched nerves in the root of a person’s neck. Sometimes this is caused by muscles that are too tight in a person’s neck. In some cases, it can be caused by a head or neck injury. Chronic neck tension is another common cause.
Other conditions that can lead or contribute to causes of occipital neuralgia include:
- osteoarthritis, especially of the upper cervical spine, which can pinch nerves
- tumors affecting nerve roots
- blood vessel inflammation
Individual attacks or episodes of occipital neuralgia can occur seemingly spontaneously, or be triggered by a light touch.
How is occipital neuralgia diagnosed?
When you make an appointment with your doctor, they’ll first ask about your medical history. They’ll ask how long you’ve experienced symptoms, and may ask questions to look for underlying conditions. During the physical exam, if they suspect occipital neuralgia instead of headaches or migraines, they’ll press on the occipital regions to see if you experience pain as a result.
To rule out other conditions and to search for the underlying cause of occipital neuralgia, your doctor may order additional imaging tests like an MRI or a CT scan. This will help them look at your spine, and search for different causes of the pain. In most cases, neurologic exams will come back with no abnormalities from the neuralgia alone.
How is occipital neuralgia treated?
A variety of different treatment options are available for occipital neuralgia. Your doctor may first recommend trying home treatment, which includes applying warm compresses to the affected area and taking NSAIDs like ibuprofen (Advil).
Your doctor may also recommend physical therapy, prescription muscle relaxers, and massage, which can help treat pinched nerves caused by tight muscles. Antiepileptic and tricyclic antidepressants can both be used to reduce symptoms as well.
If the more conservative methods don’t work, your doctor can inject a local anesthetic to your occipital area. This can provide immediate relief, and it can last up to 12 weeks.
Depending on the cause, your doctor may recommend surgery to decrease pressure on the nerves. For instance, nerve compression due to osteoarthritis or rheumatoid arthritis of the cervical spine may be eased through a surgical procedure.