Occipital Neuralgia

Causes of occipital neuralgia may include whiplash injury mechanisms, motor vehicle accidents, sports injuries, tight or overstretched soft tissues (muscles, tendons), myofascial trigger points, poor posture, blunt trauma to the back of the head or upper neck, repetitive microtrauma, or post-surgical scarring.

The diagnostic criteria, as outlined by the International Headache Society, are as follows:

• Unilateral or bilateral pain in the distribution(s) of the greater, lesser and/or third occipital nerves
• Pain has at least two of the following three characteristics:
  • Recurring in paroxysmal attacks lasting from a few seconds to minutes
  • Severe in intensity
  • Shooting, stabbing, or sharp in quality
• Pain is associated with both of the following:
  • Dysaesthesia and/or allodynia apparent during innocuous stimulation of the scalp and/or hair
  • Tenderness over the affected nerve branches and/or trigger points at the emergence of the greater occipital nerve or in the distribution of C2
• Pain is eased temporarily by local anaesthetic block of the affected nerve(s)

Treatment options for occipital neuralgia typically include medications, physical therapy, chiropractic, kinesiology, and a variety of injection or procedural options. Most commonly, the more conservative treatment options will be pursued before consideration of interventional options. Injection or procedural treatment options for treatment of occipital neuralgia may include occipital nerve blocks often combined with trigger point injections or botulinum toxin (Botox) injections.

With occipital nerve blocks, the location of the greater and less occipital nerves is identified at the back of the head and then subsequently “blocked” using local anesthetic (numbing medication). When performing trigger point injections, hyperirritable and taut bands of muscle/fascia are identified via palpation and injected with local anesthetic. With Botox injections, the musculature surrounding the occipital nerves is targeted in a similar manner as noted above and then injected with Botox to elicit neuromuscular blockade and subsequent “relaxation” of the painful muscle with resultant reduction in occipital neuralgia headache.