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Occipital Neuralgia

(C2 Neuralgia; Arnold Neuralgia)

Definition

Occipital neuralgia is a headache with pain that starts in the back of the neck or head and moves to the scalp. It happens due to a problem with the two occipital nerves in the neck.

Causes

The exact cause is not always known. Other times it may be due to injury or irritation of the nerve from problems like:
  • Trauma to the back of the head
  • Neck muscles that are very tight or tense
  • Pressure on the nerves from things like swollen blood vessels, gout, tumors, or cysts
  • Infection

Risk Factors

Things that may raise the chance of occipital neuralgia are:
  • Current or prior neck injury
  • Prior surgery to the head and neck
  • A spine, neck, or head that is not normal in structure
  • Repeat stress or strain on the neck

Symptoms

The main problem is pain that starts in the back of the neck or head and moves up the scalp. It may be sudden, sharp, burning, or throbbing. The area may also feel numb. How long it lasts differs in each person.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. A neurological exam may also be done.
Images may be taken of the head and neck. This can be done with:
An occipital nerve block may be done. A needle with numbing medicine is inserted near the nerve. If it relieves pain, then the nerve is likely the cause of the problem.
CT Scan of the Head
Nucleus Image
Copyright © Nucleus Medical Media, Inc.

Treatment

The goal of treatment is to ease or stop pain. Any underlying causes will also need to be treated.
For most, neuralgia can be relieved with:
  • Heat therapy, which may be dry, moist, or both
  • Massage therapy
  • Physical therapy to ease tense or tight muscles

Medication

Medicines that may help ease pain are:
  • Over-the-counter pain medicine, such as ibuprofen
  • Muscle relaxants
  • Antiseizure medicine
  • Antidepressants
A nerve block or corticosteroid injections may also be given. A nerve block stops the nerve from sending pain signals. A corticosteroid can ease pressure on the nerve.

Surgery

People with severe symptoms may need surgery, such as:
  • Decompression—Moving blood vessels or other tissues that are compressing the nerve
  • Nerve stimulation—Places electrodes under the skin near the nerves to send electrical impulses that block pain
  • Spinal cord stimulation—Places electrodes between the spinal cord and vertebrae to send electrical impulses that block pain
  • Neurectomy—Cuts and/or removes the nerve that causes pain

Prevention

Not all causes of occipital neuralgia can be prevented. Exercising the muscles of the neck may help.

RESOURCES

American Association of Neurological Surgeons
http://www.aans.org
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

CANADIAN RESOURCES

Canadian Neurosurgical Society
http://www.cnsfederation.org
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References

Headache—approach to the adult patient. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/headache-approach-to-the-adult-patient#TOPIC%5FIRG%5FHHZ%5FTKB. Updated November 28, 2018. Accessed April 24, 2020.
Occipital neuralgia. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Occiptal%20Neuralgia.aspx. Accessed April 24, 2020.
Occipital neuraglia. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/nervous%5Fsystem%5Fdisorders/Occipital%5FNeuralgia%5F22,OccipitalNeuralgia. Accessed April 24, 2020.
Occipital neuralgia information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Occipital-Neuralgia-Information-Page. Updated March 27, 2019. Accessed April 24, 2020.
Therapeutic pain blocks. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/neurology%5Fneurosurgery/centers%5Fclinics/headache/procedures/greater%5Foccipital%5Fnerve%5Fblock.html. Accessed April 24, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 02/2020
  • Update Date: 04/24/2020
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