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Occipital Neuralgia Treatment

What is Occipital Neuralgia?

Sufferers of Occipital Neuralgia present with a unilateral pain described as; piercing, throbbing or electric-shock like. It is experienced in the upper part of the neck, back of the head or behind the ears. Occasionally, this pain may be present in the forehead or in the scalp. These areas correlate with the distributions of the greater and lesser occipital nerves. Other symptoms can include, pain behind the eyes, visual impairments, tinnitus and nausea. Attacks generally last anywhere from a few seconds to many minutes [1].

The primary role of the occipital nerves is to run sensory information from the back of the head to the brain. Therefore, all sensory information from the back of your head and neck, travels through the Occipital Nerve. Sufferers of Occipital Neuralgia are often very sensitive, and report very light stimulus, such as lightly touching the back of the neck, can cause debilitating attacks. This could be because of the link between the Occipital Nerve and the brainstem as it passes this sensory information to the brain.

Given the similarity in symptoms of Occipital Neuralgia, with those of migraine headache, it isn’t uncommon for them to be left undiagnosed for long periods of time. One differentiating factor between the two types of headaches are duration of attacks.

Anatomy of the Occipital Nerve

There are three nerves that group to form the Occipital Nerve, they originate between the 2nd and 3rd cervical vertebrae. The Greater Occipital Nerve innervates the semispinalis capitus muscle, and also the scalp. The rest of the scalp and the area behind your ears are innervated by the Lesser Occipital Nerve. The C2/3 facet joints, the area below your scalp and semispinalis capitus are innervated by the Least Occipital Nerve [1].

What is the cause of Occipital Neuralgia?

Generally Occipital Neuralgia is caused by a disruption of signals or input to the Occipital Nerves. Because the Occipital Nerves cover such a wide area, there can be a wide range of causes. It has also been reported that Occipital Neuralgia can be caused by nerve damage as a result of surgery, stroke or neck related trauma. The damage that conditions like Multiple Sclerosis can have on the myelin sheath covering of the occipital nerve.

What are the possible causes of irritation?

The following are the reported ‘known’ causes of Occipital Neuralgia [2]:

 Vascular  Neurogenic  Osteogenic

  • Aberrant branches of the posterior inferior cerebellar artery irritating the C1/2 nerve roots
  • A cervical level arteriovenous dural fistula
  • Bulbocervical cavernomas bleeding
  • Cervical intramedullar cavernous hemangioma
  • Giant cell arteritis
  • Fenestrated vertebra artery pressing on C1/C2 nerve roots
  • Aberrant course of the vertebra artery
  • Schwannoma in the area of the craniocervical junction: schwannoma of occipital nerve
  • C2 myelitis
  • Multiple sclerosis


  • C1/C2 arthrosis, atlantodental sclerosis
  • Hypermobile C1 posterior arch
  • Cervical osteochondroma
  • Osteolytic lesion of the cranium
  • Exuberant callus formation after C1/C2 fracture



However, in some cases, patients will experience all of the symptoms of Occipital Neuralgia with no apparent cause found under investigation. In these cases, it is possible that a sensitised brainstem is the cause of their symptoms.  

This sensitised brainstem will receive typically non-threating stimulus (such as light touches to the back of the head) as a threat and will respond by causing severe pain along the nerve’s distribution. As the brain continues to recognise this input as a threat, the brainstem becomes even more sensitive, causing the problem to become recurrent. Normal daily tasks such as brushing hair, or scratching your scalp can then become regular triggers, causing debilitating symptoms.

I’ve already tried everything. What else can be done to help my Occipital Neuralgia?

Many of our patients who suffer from Occipital Neuralgia have tried many different therapies, including; strong pain-killers, anti-convulsant medication, Botox Injections or even surgery. These may have some short-term or mild benefit, but the pain always returns. This is where the Headache and Migraine Clinic can help, we are trained to specifically assess your cervical spine and the sensitivity of your brainstem, to see if they are the true cause of your Occipital Neuralgia. If that’s the case, then we can start treatment immediately, to cure the cause of your pain and not just cover up the symptoms.

Treatment will be addressing the dysfunction in your cervical spine, and then will aim to de-sensitise your brainstem with our world-leading manual techniques. Once treatment has started, we expect to see rapid results within the first 6 sessions, as we do with 85-90% of our patients. The best bit is that it is gentle, safe, non-invasive and medication-free.


Imagine living a life free from headaches and migraines and saying goodbye to medications!

To gain your recovery today contact us on 1800 HEADACHE (toll free)

1800 43 23 22

Common Headaches Treated

The Assessment

Phase 1

Accurately diagnose your condition for effective treatment

The Treatment

Phase 2

Experience the latest treatment methods that are evidence-based

The Results

Phase 3

A life free from migraines or headaches is now proven possible

The Difference

Phase 4

A medication-free solution that treats the cause not the symptons

Call for relief  1800 HEADACHE

What are Cluster Headaches?

Cluster Headaches are a rare type of headaches that affect around 0.1% of the population, according to the International Headache Society. While they are rare, it does affect males 3-4 times more frequently than females [1].

Despite being uncommon, Cluster Headaches are regarded as being the most severe and debilitating type of headache. Research has shown Cluster Headaches frequently described as having the highest pain levels [2], out of all 300 different types of headache and migraine. Cluster Headache attacks occur in cycles, and will often wake sufferers during the night, or at regular times during the day. Attacks generally last between 15-180 minutes, and can happen multiple times per day, or once every couple of days [1, 2]. People who suffer from Cluster Headaches generally experience periods of attacks, or “cluster periods” that can last weeks or months. These periods are then followed by periods of remission lasting weeks, months or even years. The pain is often severe, on one-side of the head, and generally around the eye and/or temple region. Cluster Headaches have adopted the nickname, ‘suicide headaches’ due to their severe and debilitating nature [2].

What are the signs and symptoms?

Cluster Headaches are often severe enough that a sufferer cannot keep still during an attack. They may pace back and forth, have to take a shower, or even resort to banging their head in an attempt to reduce the pan.

Symptoms commonly associated with Cluster Headaches include [2]:

  • Severe pain around one eye, that can radiate further around the face or neck
  • Restlessness, shortness of breath and/or a sweaty face
  • Watery/teary eyes or eye redness
  • Swollen or droopy eyelids
  • Runny or congested nose
  • Pale or flushed skin
  • Pain is unilateral, or affects only one side

What are the different types of Cluster Headache?

There are 2 types of cluster headache.

Episodic Cluster Headache

Cluster Headaches most commonly occur episodically. This is when sufferers experience bouts of “cluster periods” that can last for weeks or months, followed by an extended period in remission that can last up to years. They can occur seasonally or at set times each year. Episodic Cluster Headaches account for up to 80% of all Cluster Headaches [1, 2].

Chronic Cluster Headache

When Cluster Headaches occur without a prolonged period of remission, they are termed a Chronic Cluster headache. Sufferers often have “cluster periods” that will last over a year. While they may have days without attacks, the remissions will not last longer than a month.

What are the risk factors?

  • Men are 5-6 times more likely to experience cluster headaches
  • Sufferers are generally heavy smokers
  • Higher alcohol consumption may be a factor
  • Cluster Headaches most commonly affect people aged 20-50, but can occur at any age
  • People with family members who are sufferers may be at a higher risk

What causes Cluster Headaches?

Historically, it was believed that cluster headaches, as well as migraines, were caused by the dilation of blood vessels in the head, causing pain. This was thought because medications, like triptans, are effective at relieving the pain if taking early enough in an attack. It was believed that triptans prevent this vessel dilation. However, recent research has shown that Cluster Headache and migraine sufferers do not experience blood vessel dilation at any different levels to people who do not suffer. So, how do these medications work?

Modern research has shown that Cluster Headaches and migraines arise from increased sensitivity in the central nervous system [2], more specifically, a sensitised brainstem which is located in the upper cervical spine (the upper neck). Faults in the upper neck can lead to this sensitised brainstem, which then can refer severe pain and associated symptoms into the head and face [3]. Triptan medication has also more recently been shown to de-sensitise the brainstem [4], as well as its original purpose of constricting blood vessels in the head. This would explain why they work, as well as identifying a sensitised brainstem and the cervical spine as a cause of cluster headaches.

I've tried it all, is there anything that can help me?

While Cluster Headaches are very uncommon, they are still experienced in the Gold Coast region. The severity of symptoms causes sufferers to try a range of therapies in an attempt to resolve them, with mixed results. Often, they have tried; medications, injection therapy, or even surgical interventions such as, nerve blocks or blood vessel cauterisation.

At The Headache and Migraine Clinic, we aim to use the most modern research to find the root cause of your cluster headaches. If we can determine that a sensitised brainstem is the cause of your headaches, then we can use world-leading treatment techniques to address the faults in your neck and de-sensitise the brainstem. We have seen plenty of Cluster Headache sufferers at our clinics, and have an 85-90% success rate with our treatment technique. The best part is that it is safe, non-invasive and medication-free.

Imagine living a life free from headaches and migraines and saying goodbye to medications!

To gain your recovery today contact us on 1800 HEADACHE (toll free)

1800 43 23 22

Common Headaches Treated