Occipital Neuralgia: Symptoms, Causes and Treatments

January 26, 2024
November 28, 2021
Occipital Neuralgia: Symptoms, Causes and Treatments

There is one headache disorder that more commonly presents as a feature of other headaches than as its own unique headache pain.  Occipital neuralgia is defined as pain in the occiput - or back of the head.  That pain is in the area of the branches of nerves in the back of the head, the occipital nerves.  The pain is reproducible - so if you or someone touches those areas the pain you experience exacerbates.  And the final part of the diagnostic process is that the pain improves nearly completely after an injection called an occipital nerve block is performed. 

The occipital nerves are actually branches of nerve roots of the upper spine.  The nerve roots C2-C4 branch out into the greater, lesser and third occipital nerves.  For this reason, someone with cervicogenic headache - headache pain due to either joint problems in the spine, or muscle tension and spasm in the neck and shoulder area - may begin to experience occipital neuralgia as a result of irritation of the nerve roots, or compression of the nerves tightly in muscle.  People who experience chronic migraine may also have chronic tension of the scalp muscles leading to occipital neuralgia.  When these other headache diagnoses are the cause of occipital neuralgia, the ideal treatment is focusing on prevention of the underlying headache disorder. 

It is possible, though, for occipital neuralgia to occur alone, as its own primary headache.  This can happen as a result of head trauma to the back of the head, and can also happen spontaneously.  As we mentioned above, an occipital nerve block is necessary to diagnose occipital neuralgia.  This is typically done with a combination of numbing medicines in the lidocaine family, where the greater and lesser occipital nerve branches are targeted and injected.  If you do have occipital neuralgia, the reproducible pain should resolve near instantly.  

The treatments for occipital neuralgia vary from injections, to medications to physical therapy.  Some people who respond well to occipital nerve blocks may only need this treatment for their headache.  These injections, if needed, can be repeated every 4-8 weeks.  Gabapentin is a medication that is commonly used for many nerve pain issues, and can be used here as well.  Some antidepressant medications that help nerve pain can also be helpful, like amitriptyline, nortriptyline, venlefaxine and duloxetine. Physical therapy can be a very helpful treatment, especially if there is also muscle spasm in the neck, shoulder or scalp areas.   

The first step on the way to finding the right treatment is the right diagnosis by a neurologist. If you experience symptoms of occipital neuralgia, Neura Health can help you get the right treatment for your unique case. Join us today

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Thomas Berk, MD FAHS
Thomas Berk is Medical Director at Neura Health, where he treats Neura patients via video visit. He is a former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine.
About the Author
Thomas Berk, MD FAHS is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is a Fellow of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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