What is Occipital Neuralgia?

Occipital Neuralgia (ON) is a chronic pain condition caused by compression and irritation to the occipital nerves, often the result of a concussion/whiplash injury.  The pain can be bilateral and/or unilateral.  Additionally, the pain can be isolated to the front and/or back of the head.  The pain from Occipital Neuralgia can be intermittent or it can often become chronic.
 

Diagnosis:

Occipital Neuralgia is often considered a 'diagnosis of exclusion.'  In other words, once imaging comes back clear and other ailments have been ruled out, ON is then considered.  Your physician might ask if you have a history of trauma or injury and will continue to do a physical exam.  During the physical exam, they might apply pressure to the scalp and occipital area to see if these areas are sensitive.  Sometimes doctors also use diagnostic nerve blocks in the occipital area.  If you have any relief from a nerve block, that usually is an indicator that the occipital nerves are causing the problem.  Another way to diagnose ON is based on the way the pain travels.  Oftentimes, people with ON will be able to describe the pain as starting in the back of the head, traveling through the occipital nerve, all the way to the front of the head.

Occipital Neuralgia Diagram

Symptoms include:

-Constant/intermittent 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

Medical Procedures and Surgical Options:

Injections: Botox, Trigger Point, Nerve Blocks

Nerve blocks can be used as both a diagnostic tool and as a form of treatment.  Degree and duration of relief, if any, can range from a couple of minutes to several months.  Certain types of injections require multiple rounds of treatment before relief can be achieved, while others require continuous treatment.

Radio-Frequency Ablation (RFA)

This is a temporary pain management technique in which 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*

Nerve decompression surgery is typically performed by reconstructive surgeons who specialize in nerve issues.  Through this surgery, the occipital nerves are "released" from the scar tissue, fascia, muscle tissue, etc. that was compressing them. 

Neuro Stimulator Implant (i.e. Omega Procedure/Reed Procedure)*

Neurostimulators have been described as a "pacemaker for pain."  They consist of a battery with multiple leads.  The battery is usually placed in the chest while the leads are placed in the areas of pain, whether it be your forehead, back of head, or both.  The leads are connected to a battery pack, which is placed beneath the skin, usually in the chest.  Electrical impulses are sent to interrupt the pain signals from reaching the brain.  A remote control is used to adjust the frequency, duration, intensity, etc. of the impulses to best suit your pain levels.  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.