Occipital Neuralgia Treatment

Anatomy of the Occipital Nerve

The occipital nerves are a group of three nerves that arise from between the second and third cervical vertebrae (C2/C3) and work together to transmit sensory information from the head and neck. The greater occipital nerve innervates the semispinalis capitis muscle and the scalp, playing a key role in head and neck sensation.

The lesser occipital nerve supplies sensation to the scalp and the area behind the ears. Meanwhile, the third occipital nerve (sometimes called the least occipital nerve) provides sensation to the semispinalis capitis muscle (a small region just below the base of the skull) and the C2/C3 zygapophyseal joints. These nerves are critical pathways for transmitting pain messages involved in occipital neuralgia.

Vascular causes of occipital nerve irritation

Vascular causes of occipital neuralgia can result from structural changes or abnormalities affecting the blood vessels near the cervical spine and occipital nerves. These include:

• Irritation of the C1/C2 nerve roots by an aberrant branch of the posterior inferior cerebellar artery, leading to occipital nerve irritation and occipital neuralgia symptoms
• Dural arteriovenous fistula at the cervical level causing abnormal blood flow that may compress the occipital nerves
• Bleeding from bulbocervical cavernomas, resulting in pressure on the occipital nerves and surrounding structures
• Cervical intramedullary cavernous hemangioma contributing to nerve compression and occipital neuralgia pain
• Giant cell arteritis causing inflammation that can decrease blood flow and irritate the occipital nerves
• Fenestrated vertebral artery pressing on the C1/C2 nerve roots, disrupting pain messages from the cervical spine

Aberrant course of the vertebral artery increasing the risk of occipital nerve irritation and contributing to severe pain symptoms

Neurogenic causes of occipital nerve irritation

• Schwannoma affecting the occipital nerves at the craniocervical junction – a benign tumour that grows from the nerve sheath (the protective covering of certain nerve cells), potentially compressing the occipital nerves and causing occipital neuralgia symptoms, including sharp pain and nerve irritation
• C2 myelitis – inflammation of the cervical spinal cord that can disrupt pain messages and lead to occipital neuralgia pain and severe headaches
• Multiple sclerosis – a neurological disorder that damages the protective myelin sheath around nerve cells, increasing the risk of occipital nerve irritation and contributing to chronic occipital neuralgia symptoms

Osteogenic causes of occipital nerve irritation

• C1/C2 arthrosis and atlantodental sclerosis – degenerative changes in the cervical spine that may compress the occipital nerves, acting like a pinched nerve, and contribute to occipital neuralgia pain and neck pain
• Hypermobile C1 posterior arch – excessive movement at the top of the cervical spine placing stress on the occipital nerves, potentially causing neck pain and symptoms of occipital neuralgia
• Cervical osteochondroma – a benign bone tumour that can irritate or compress the greater occipital nerve, leading to sharp pain and nerve damage
• Osteolytic lesion of the cranium – bone loss in the skull that may expose or damage nearby occipital nerves, increasing the risk of nerve irritation
• Exuberant callus formation after C1/C2 fracture – excessive bone healing that places pressure on the occipital nerves, triggering occipital neuralgia symptoms such as aching pain and sharp pain in the upper neck and back of the head

How is Occipital Neuralgia Diagnosed?

Diagnosing occipital neuralgia begins with a detailed assessment of your symptoms, medical history, and a physical examination of the head, neck, and upper cervical spine. Our clinicians at Sydney Headache and Migraine Clinic™ carefully assess for tenderness along the greater and lesser occipital nerves, reproduction of occipital neuralgia pain through palpation, and hypersensitivity in the affected areas.

Occipital neuralgia is often misdiagnosed as other headache disorders, including chronic migraine headaches, due to overlapping symptoms like neck pain and head pain. Accurate diagnosis is crucial to ensure the most effective occipital neuralgia treatment and pain relief.

In some cases, diagnostic nerve blocks may be recommended. These temporarily block pain messages from the occipital nerves, helping to confirm the diagnosis. Imaging such as MRI or CT scans may also be used to rule out structural causes like nerve compression or a pinched nerve contributing to occipital neuralgia symptoms.

Common Treatment Options for Occipital Neuraglia

There are several treatment options available for occipital neuralgia, ranging from conservative methods to more invasive interventions. Over-the-counter pain relief medications, muscle relaxers, and nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to manage symptoms. In some cases, occipital neuralgia medications such as anticonvulsants or antispasmodics may be prescribed to help relieve pain.

Other options include occipital nerve blocks, steroid injections, or botox injections aimed at reducing inflammation and blocking pain messages from the occipital nerves. More invasive treatments like occipital nerve stimulation or spinal cord stimulation may also be considered, using electrical impulses to disrupt pain signals. While these treatments can sometimes reduce occipital neuralgia pain, they often focus on symptom management rather than addressing the underlying cause.