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 2^nd and 3^rd 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.