Occipital Neuralgia

What is occipital neuralgia?

Occipital neuralgia is a type of headache disorder. The condition occurs when your occipital nerves become inflamed. Your occipital nerves carry messages from your brain through your scalp. Nerve inflammation is irritation or swelling around your nerve.

Who might get occipital neuralgia?

Occipital neuralgia can affect anyone. You may be more likely to suffer from occipital neuralgia if you have:

• Degenerative disk disease.
• Diabetes.
• Gout.
• Osteoarthritis of your upper spine.
• Vasculitis (blood vessel inflammation).

How long does a bout of occipital neuralgia last?

Occipital neuralgia pain may last for only a few seconds or may affect you for hours. For most people, symptoms decrease with noninvasive treatments. Typically, the pain goes away when the nerve damage heals or decreases.

What causes occipital neuralgia?

The most common cause of occipital neuralgia is pinched nerves or muscle tightness. You may also develop occipital neuralgia after a head or neck injury.

What are the symptoms of occipital neuralgia?

Occipital neuralgia symptoms affect your head and neck. If you have occipital neuralgia, your symptoms may occur only briefly. Sometimes, symptoms are chronic (long-lasting).

Occipital headache pain may start behind one eye or at the back of your head. The pain may feel like:

• Aching.
• Burning.
• Electric shock.
• Sudden, sharp or piercing.
• Throbbing.

How is occipital neuralgia diagnosed?

Diagnosing occipital neuralgia can be tricky. The condition causes many of the same symptoms as migraines and other headache disorders. No one conclusive test will confirm occipital neuralgia.

Your neurologist (brain and spine specialist) may order tests such as:

• CT scans or MRIs to get a better picture of your spine.
• Occipital nerve blocks to determine if your pain comes from your occipital nerve.

How is occipital neuralgia treated?

Occipital neuralgia treatment focuses on decreasing pain when you have symptoms. A range of nonsurgical or surgical treatments can help.

Nonsurgical treatment may include:

• Hot therapy, or using heating pads on the affected area.
• Massage therapy.
• Nerve blocks, an injection of numbing medication and steroids.
• Physical therapy.
• Botulinum toxin (Botox®) injections to decrease inflammation.

Your healthcare provider may also prescribe medications such as:

• Anticonvulsants, drugs to treat seizures or other brain overactivity.
• Muscle relaxants.
• Nonsteroidal anti-inflammatory drugs.

If your symptoms don’t improve after trying nonsurgical treatments, your healthcare provider may recommend surgery. Surgical treatment for occipital neuralgia includes:

• Occipital nerve stimulation: Placing electrodes on your occipital nerve to stop pain signals from reaching your brain.
• Spinal cord stimulation: Placing electrodes on your spinal cord to block pain signals from reaching your brain.

How soon after treatment will I feel better?

If your pain is mild to moderate, you may feel better after a week or two of using treatments such as medications, therapy and nerve blocks. If your pain is more intense, it may take four to six weeks before you notice an improvement.

If you have a spinal cord stimulator, for example, you may need to return to your healthcare provider to adjust the stimulation settings every few weeks until you feel pain relief.

How can I prevent occipital neuralgia?

If you have occipital neuralgia, you may not be able to prevent pain altogether. Massaging your neck and stretching can help release tight neck muscles. Tight neck muscles can lead to symptom flares.

For example, try practicing chin tucks a few times a week. (But if the exercise increases your pain, stop immediately and see your healthcare provider.) To perform a chin tuck:

• Stand with your back against the wall and your feet shoulder-width apart.
• Slowly tuck your chin toward your chest and pull your head back until it meets the wall.
• Hold for five to 10 seconds.

What is the outlook for people with occipital neuralgia?

Occipital neuralgia isn’t life-threatening. With the proper treatment, pain improves for most people. Once your nerves heal, the pain usually goes away. You may need to continue stretching or taking medication to keep the pain from returning.

Does occipital neuralgia return after treatment?

Depending on the type of treatment you use, occipital neuralgia pain may come back. For example, if your healthcare provider gives you a steroid injection, the effects of the shot may wear off after three to six months. You may need to visit your healthcare provider from time to time to manage occipital neuralgia symptoms.

When should I go to the ER?

Most of the time, occipital neuralgia pain isn’t an emergency. You should seek immediate treatment if head or neck pain also causes:

• Headaches.
• Fever.
• Double vision.
• Vision loss.
• Weakness.
• Numbness.
• Speech issues.
• Sudden confusion.

A note from Cleveland Clinic

Occipital neuralgia can cause sudden, sharp and intense pain. Usually, this pain runs along your scalp or feels like a throbbing sensation behind your eye. Occipital neuralgia shares many of the same symptoms as other headache disorders. Treatment options like hot and cold therapy, stretching and massage relieve the pain for many people. If your symptoms don’t go away with noninvasive treatment, you may be a candidate for a spinal cord stimulator or occipital nerve stimulator. Treatment relieves the symptoms for most people.