What is Occipital Neuralgia?

Occipital Neuralgia (ON) is a chronic pain condition that is caused by inflammation or compression to the occipital nerves, usually as a result of a concussion/whiplash injury.   The pain can be bilateral and/or unilateral or isolated to the front and/or back of the head. 

When searching "Occipital Neuralgia" on the internet, ON is often described as a headache caused by tightness in the neck that can be treated by doing light stretches, massage, and taking oral medications.  This description must refer to the more mild cases.  We have met people from all over the world who are suffering and those treatment options don't typically provide long lasting relief, in some cases it makes their symptoms worse.  The pain can be intermittent or can become chronic.

Diagnosis:

There aren't any tests that can tell for sure if you have ON.  After other conditions are ruled out, a doctor can use your history of trauma or injury and a physical and neurological exam to diagnose.  During the physical exam, they put pressure on the scalp and occipital area to see if these areas are sensitive.  Sometimes doctors also use diagnostic nerve blocks.  If you have any relief from a nerve block, that usually is an indicator that the occipital nerves are causing the problem.

Medical Procedures and Surgical Options (for severe cases)

Symptoms include:

-Constant/almost constant head pain 

-Throbbing pain at the base of the skull

-Burning pain throughout head

-Neck pain

-Electric zap feelings throughout head

-Shooting pains in head

-Pain radiating through the arms

-Light, scent, and sound sensitivity

-Eye fatigue and eye strain

-Fatigue

-Dizziness/lightheaded

-Pain above eyebrows

-Difficulty focusing

-Increase of symptoms with activity

Injections: Botox, Trigger Point, Nerve Blocks

Nerve blocks, trigger point injections and Botox can be used both as a diagnostic tool and treatment.  Degree and duration of relief, if any, can range from a couple of minutes to several months.  Certain types of injections require a few rounds of treatment before relief can be achieved.

Radio-Frequency Ablation (RFA)

This is a temporary pain management technique where the nerves that are causing the pain are "blasted" with short bursts of radio frequency waves to help reduce the pain signals being sent to the brain.

Nerve Decompression Surgery*

This is performed increasingly  by reconstructive surgeons who specialize in nerve issues. During this surgery the occipital nerves are released from whatever is compressing them, including (e.g. muscles, scar tissue, fascia)

Neuro Stimulator Implant (i.e. Omega Procedure/Reed Procedure)-for pain relief*

This has been described as a "pacemaker for pain."  It consists of placement of nerve stimulator leads under the skin in the areas of pain (often the forehead and/or occipital area) and the leads are attached to a battery, usually placed in the chest. From this, electrical impulses are produced in an attempt to interrupt the pain signals being felt. A remote control is used to adjust to personalized programs to assist with pain relief.  It doesn't work for everyone.  A trial is conducted first with temporary lead placement and an external battery to see if it is a helpful way to reduce the pain. If successful, then consideration for a permanent implant can be discussed.

*Both Nerve Decompression and Nerve Stimulator surgeries are often deemed experimental by insurance companies.

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