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Journal articles on the topic 'Occipital Neuralgia'

Author: Grafiati

Published: 3 June 2025

Last updated: 19 July 2025

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1

Katta-Charles, Sheryl D. "Craniofacial neuralgias." NeuroRehabilitation 47, no. 3 (2020): 299–314. http://dx.doi.org/10.3233/nre-208004.

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While non-headache, non-oral craniofacial neuralgia is relatively rare in incidence and prevalence, it can result in debilitating pain. Understanding the relevant anatomy of peripheral branches of nerves, natural history, clinical presentation, and management strategies will help the clinician better diagnose and treat craniofacial neuralgias. This article will review the nerves responsible for neuropathic pain in periorbital, periauricular, and occipital regions, distinct from idiopathic trigeminal neuralgia. The infratrochlear, supratrochlear, supraorbital, lacrimal, and infraorbital nerves mediate periorbital neuralgia. Periauricular neuralgia may involve the auriculotemporal nerve, the great auricular nerve, and the nervus intermedius. The greater occipital nerve, lesser occipital nerve, and third occipital nerve transmit occipital neuralgias. A wide range of treatment options exist, from modalities to surgery, and the evidence behind each is reviewed.

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Molina, Omar Franklin, Rise Consolação Iuata Rank, Bruno Ricardo Huber Simião, et al. "Occipital neuralgia as a true neuropathic pain." Revista Neurociências 22, no. 2 (2014): 242–48. http://dx.doi.org/10.34024/rnc.2014.v22.8106.

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Objective. Assess frequency of neuropathic symptoms in occipital neuralgia, migraine and tension-type headache, and discuss mechanism in occipital neuralgia. Method. Criteria for occipital neuralgia, migraine, tension-type headache, craniomandibular disorders, bruxing behavior, clinical examination, and questionnaires were used. Results. Mean ages are 37.3±1.7 years in occipital neuralgia patients, 36.5±11.8 years in migraine patients, and 33.0±12.3 years in tension-type headache patients. Frequencies of electric shock-like, stabbing or shooting pain, numbness, very intense pain, a burning description, a pain generating zone and intermittent descriptions were 54.3%, 77.1%, 34.3%, 100%, 68.6%, 100%, and 57.1%, respectively in occipital neuralgia patients, 6.3%, 18.8%, 0%, 100%, 12.5%, 0%, and 0%, respectively, in migraine patients; 0%, 17.6%, 0%, 18.6%, 0.9%, 0% and 0%, respectively, in tension-type headache patients. Comparing neuropathic symptoms between occipital neuralgia and migraine, and between occipital and tension-type headache, neuropathic symptoms were present almost exclusively in occipital neuralgia patients. Conclusions. Neuropathic symptoms differentiate occipital neuralgia from migraine and from tension-type headache. Very intense pain is more frequent in occipital neuralgia and migraine than in tension-type headache individuals.

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3

Pakzaban, Peyman. "Transarticular screw fixation of C1–2 for the treatment of arthropathy-associated occipital neuralgia." Journal of Neurosurgery: Spine 14, no. 2 (2011): 209–14. http://dx.doi.org/10.3171/2010.10.spine09815.

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Two patients with occipital neuralgia due to severe arthropathy of the C1–2 facet joint were treated using atlantoaxial fusion with transarticular screws without decompression of the C-2 nerve root. Both patients experienced immediate postoperative relief of occipital neuralgia. The resultant motion elimination at C1–2 eradicated not only the movement-evoked pain, but also the paroxysms of true occipital neuralgia occurring at rest. A possible pathophysiological explanation for this improvement is presented in the context of the ignition theory of neuralgic pain. This represents the first report of C1–2 transarticular screw fixation for the treatment of arthropathy-associated occipital neuralgia.

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4

Son, Byung-chul. "Referred Trigeminal Facial Pain from Occipital Neuralgia Occurring Much Earlier than Occipital Neuralgia." Case Reports in Neurological Medicine 2020 (August 24, 2020): 1–6. http://dx.doi.org/10.1155/2020/8834865.

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We report a very rare case in which a patient believed to have auriculotemporal neuralgia due to the repeated recurrence of paroxysmal stabbing pain in the preauricular temporal region for four years developed occipital neuralgia, which finally improved with decompression of the greater occipital nerve (GON). The pain of occipital neuralgia has been suggested to be referred to the frontoorbital (V1) region through trigeminocervical interneuronal connections in the trigeminal spinal nucleus. However, the reports of such cases are very rare. In occipital neuralgia, the pain referred to the ipsilateral facial trigeminal region reportedly also occurs in the V2 and V3 distributions in addition to that in the V1 region. In the existing cases of referred trigeminal pain from occipital neuralgia, continuous aching pain is usually induced, but in the present case, typical neuralgic pain was induced and diagnosed as idiopathic auriculotemporal neuralgia. In addition, recurrent trigeminal pain occurred for four years before the onset of occipital neuralgia. If the typical occipital neuralgia did not develop in four years, it would be impossible to infer an association with the GON. This case shows that the clinical manifestations of referred trigeminal pain caused by the sensitization of the trigeminocervical complex by chronic entrapment of the GON can be very diverse.

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Molina, Omar Franklin, Zeila Coelho Santos, Bruno Ricardo Huber Simião, Sonia Maria Paiva Torres, Ricardo Léllis Marçal, and Vanessa Bastos Penoni. "Pain is more widespread and referred to trigeminal areas in occipital neuralgia." Revista Neurociências 22, no. 3 (2014): 438–45. http://dx.doi.org/10.34024/rnc.2014.v22.8072.

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Objetctive. Evaluate local and referred pain in occipital neuralgia. Method. Charts review of 32 occipital neuralgia, 16 migraine without aura and 102 tension-type headache individuals, respectively. Criteria for craniomandibular disorders, bruxism, headaches. Questionnaires to assess pain sites and descriptors for headaches. Results. Common areas of local/referred pain in occipital neuralgia were the temporal, frontal, occipital, sub-occipital, retro-orbital, cervical and vertex (78.1% cases). Common areas of referred pain in tension-type headache were located in the bilateral temporal and frontal areas (65=63.7%). Other areas of referred pain in tension-type headache were the cervical, vertex, sub-occipital and parietal areas (21.6%). Common areas of local and referred pain in migraine (62.5%) were located in the right anterior temporal area, right anterior temporal, parietal and occipital, left anterior temporal and parietal area, frontal and cervical areas. The median of painful anatomic zones were occipital neuralgia 3.5, tension-type headache 2.0, migraine 2.0; and Controls 0.5 (Kruskal-Wallis statistics with post-test p<0.0001). Conclusions. Pain in occipital neuralgia was reported in a more widespread anatomic area and in more anatomic zones as compared to migraine and tension-type headache. The latter was reported usually bilaterally in the frontal and temporal areas.

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6

Choi, Il, and Sang Ryong Jeon. "Neuralgias of the Head: Occipital Neuralgia." Journal of Korean Medical Science 31, no. 4 (2016): 479. http://dx.doi.org/10.3346/jkms.2016.31.4.479.

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7

Anthony, Michael. "Occipital Neuralgia." Cephalalgia 9, no. 10_suppl (1989): 174–75. http://dx.doi.org/10.1177/0333102489009s1096.

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8

Bertz, Patrick E. "Occipital neuralgia." Nurse Practitioner 45, no. 11 (2020): 12–16. http://dx.doi.org/10.1097/01.npr.0000718500.46346.2b.

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9

Manolitsis, Nicholas. "Pulsed Radiofrequency for Occipital Neuralgia." Pain Physician 6;17, no. 6;12 (2014): E709—E717. http://dx.doi.org/10.36076/ppj.2014/17/e709.

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Background: The clinical application of pulsed radiofrequency (PRF) by interventional pain physicians for a variety of chronic pain syndromes, including occipital neuralgia, is growing. As a minimally invasive percutaneous technique with none to minimal neurodestruction and a favorable side effect profile, use of PRF as an interventional neuromodulatory chronic pain treatment is appealing. Occipital neuralgia, also known as Arnold’s neuralgia, is defined by the International Headache Society as a paroxysmal, shooting or stabbing pain in the greater, lesser, and/or third occipital nerve distributions. Pain intensity is often severe and debilitating, with an associated negative impact upon quality of life and function. Most cases of occipital neuralgia are idiopathic, with no clearly identifiable structural etiology. Treatment of occipital neuralgia poses inherent challenges as no criterion standard exists. Initially, conservative treatment options such as physical therapy and pharmacotherapy are routinely trialed. When occipital neuralgia is refractory to conservative measures, a number of interventional treatment options exist, including: local occipital nerve anesthetic and corticosteroid infiltration, botulinum toxin A injection, occipital nerve subcutaneous neurostimulation, and occipital nerve PRF. Of these, PRF has garnered significant interest as a potentially superior, safe, non-invasive treatment with long-term efficacy. Objective: The objective of this article is to provide a concise review of occipital neuralgia; and a concise, yet thorough, evidence-based review of the current literature concerning the use of PRF for occipital neuralgia. Study Design: Review of published medical literature up through April 2013. Setting: The Center for Pain Medicine and Regional Anesthesia, the University of Iowa Hospitals and Clinics. Results: A total of 3 clinical studies and one case report investigating the use of PRF for knee occipital neuralgia have been published worldwide. Statistically significant improvements in pain, quality of life, and adjuvant pain medication usage have been demonstrated. Limitations: Lack of randomized control trials, small study sample sizes, an absence of diagnostic block imaging guidance, and the use of outcome measures that are inherently subjective, limiting objectivity and introducing an unquantifiable degree of bias. Conclusion: Clinical studies to date examining the efficacy of PRF as a treatment for occipital neuralgia have yielded promising results, demonstrating sustained improvement in pain, quality of life, and adjuvant pain medication usage. Despite these encouraging clinical studies, conclusive evidence in support of PRF as an interventional treatment option for occipital neuralgia awaits to be seen. Key words: Occipital neuralgia, pulsed radiofrequency, PRF, greater occipital nerve, lesser occipital nerve, chronic pain, interventional pain management

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O’Neill, Francis, Turo Nurmikko, and Claudia Sommer. "Other facial neuralgias." Cephalalgia 37, no. 7 (2017): 658–69. http://dx.doi.org/10.1177/0333102417689995.

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Premise In this article we review some lesser known cranial neuralgias that are distinct from trigeminal neuralgia, trigeminal autonomic cephalalgias, or trigeminal neuropathies. Included are occipital neuralgia, superior laryngeal neuralgia, auriculotemporal neuralgia, glossopharyngeal and nervus intermedius neuralgia, and pain from acute herpes zoster and postherpetic neuralgia of the trigeminal and intermedius nerves. Problem Facial neuralgias are rare and many physicians do not see such cases in their lifetime, so patients with a suspected diagnosis within this group should be referred to a specialized center where multidisciplinary team diagnosis may be available. Potential solution Each facial neuralgia can be identified on the basis of clinical presentation, allowing for precision diagnosis and planning of treatment. Treatment remains conservative with oral or topical medication recommended for neuropathic pain to be tried before more invasive procedures are undertaken. However, evidence for efficacy of current treatments remains weak.

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Ko, Hak-cheol, Jin-gyu Choi, and Byung-chul Son. "Hemifacial Trigeminal Pain Referred from Occipital Neuralgia Due to Compression of the Greater Occipital Nerve by the Occipital Artery." Journal of Neurological Surgery Part A: Central European Neurosurgery 79, no. 05 (2018): 442–46. http://dx.doi.org/10.1055/s-0038-1655751.

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Although pathologic vascular contact between the occipital artery and the greater occipital nerve (GON) at the crossing point in the nuchal subcutaneous layer can cause occipital neuralgia, referred hemifacial trigeminal pain from chronic occipital neuralgia owing to this cause is extremely rare.A 61-year-old female patient with left-sided occipital neuralgia for 4 years presented with a new onset of left-sided hemifacial pain. Decompression of the left GON from pathologic contacts with the occipital artery resulted in immediate relief for hemifacial pain and chronic occipital neuralgia. The present case implies that sensitization and hyperactivity of the trigeminocervical complex that receives the convergent input from trigeminal and high cervical occipital nociceptive pathways can be a pathogenic mechanism in referred hemifacial pain from occipital neuralgia. In the present case, a branching tributary of the occipital artery at the crossing point forming a constricting loop above the course of the GON was found to be the cause of entrapment. Because the occipital artery is reported to be consistently located superficial to the GON at the crossing point, a spatial relationship between the occipital artery and the GON rather than a mere adhesion or contact might have pathologic significance in the development of occipital neuralgia.

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12

Siahaan, Yusak Mangara Tua. "The role of occipital nerve block with ultrasound guidance in occipital neuralgia cases." Romanian Journal of Neurology 21, no. 1 (2022): 22–27. http://dx.doi.org/10.37897/rjn.2022.1.4.

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Introduction. Occipital neuralgia (ON) is a well-known cause of headache that affecting the posterior head at the occipital nerve(s) distribution. It is a multiple-factor clinical condition resulting from the pathology of the greater, lesser or third occipital nerve. Interventional therapy, such as occipital nerve block (ONB), is one of the various modalities that could be normally considered when the conservative wasn’t satisfying. Besides as effective treatment, ONB also used as an important diagnostic procedure for occipital neuralgia. Content. Currently, there is no a complete consensus among practitioners regarding the optimal therapy for occipital neuralgia although many modalities offered. ONB traditionally performed with blinded approach relying on anatomic landmarks create the higher risks of injection in the occipital artery and/or block failure. Therefore, ONB with ultrasound guidance becomes solution to improve the safety and efficacy of therapy especially in occipital neuralgia cases. Conclusion. Occipital nerve block with ultrasound guidance is recommended as primary interventional therapy for occipital neuralgia cases.

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13

Vanelderen, Pascal, Arno Lataster, Robert Levy, Nagy Mekhail, Maarten van Kleef, and Jan Van Zundert. "8. Occipital Neuralgia." Pain Practice 10, no. 2 (2010): 137–44. http://dx.doi.org/10.1111/j.1533-2500.2009.00355.x.

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14

Raffaelli, Edgard, Orlando J. Martins, and AméRico Dos Santos P. Dágua Filho. "Minor Occipital Neuralgia." Cephalalgia 7, no. 6_suppl (1987): 173–74. http://dx.doi.org/10.1177/03331024870070s656.

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15

Lee, Chang-ik, and Byung-chul Son. "V2 Trigeminal Referred Pain from Chronic Occipital Neuralgia Caused by Entrapment of the Greater Occipital Nerve." Indian Journal of Neurosurgery 08, no. 01 (2019): 076–80. http://dx.doi.org/10.1055/s-0038-1676662.

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AbstractAlthough entrapment of the greater occipital nerve (GON) is a well-known cause of occipital neuralgia, occurrence of referred hemifacial trigeminal pain involving V2 distribution from chronic occipital neuralgia is rare. A 67-year-old female patient with intermittent left-sided occipital neuralgia of 10-year duration presented with a new onset of left-sided hemifacial pain of 5-month duration. With aggravation of left-sided occipital neuralgia, continuous burning pain and paresthesia gradually developed in her left malar and periorbital area. They also spread to her left upper lip. Severe compression of the left GON by tendinous aponeurotic attachment of the trapezius was found intraoperatively. Decompression of the left GON from chronic entrapment resulted in immediate relief for her hemifacial pain and chronic occipital neuralgia. These findings provide clinical affirmation of the existence of trigeminal/cervical convergence and hypersensitivity. Chronic irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex receiving convergent input from dural and cervical structures. Referred trigeminal pain from chronic occipital neuralgia may extend to V2 in addition to V1 trigeminal distribution.

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Son, Byung-chul. "Diagnosis and treatment of occipital neuralgia: focus on greater occipital nerve entrapment syndrome." Journal of the Korean Medical Association 66, no. 1 (2023): 31–40. http://dx.doi.org/10.5124/jkma.2023.66.1.31.

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Background: Occipital neuralgia is defined as paroxysmal shooting, or stabbing pain in the posterior part of the scalp, in the distribution of the greater and lesser occipital nerves. Occipital neuralgia may present only as an intermittent stabbing pain, but different opinions exist on its cause and diagnostic criteria.Current Concepts: According to the latest version of headache classification, only paroxysmal stabbing pain is included in the diagnostic criteria, and persistent aching pain is excluded. Pain intensity was also limited to severe cases. It has therefore become difficult to classify existing occipital neuralgia, whose main symptom is persistent pain rather than paroxysmal stabbing pain. Occipital neuralgia is classified as either idiopathic or secondary. Secondary occipital neuralgia is caused by structural lesions innervating the trigeminocervical complex (TCC) in the upper spinal cord, the dorsal root of second cervical cord, and the greater occipital nerve (GON).Discussion and Conclusion: Although idiopathic occipital neuralgia has no cause, the entrapment of the GON in the tendinous aponeurotic attachment of the trapezius muscle at the superior nuchal line has recently been proposed as an etiology. Chronic, irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the TCC receiving convergent input from trigeminal and occipital structures. TCC sensitization induces referred pain in the facial trigeminal area.

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Son, Byung-chul, and Jin-gyu Choi. "Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve." Case Reports in Neurological Medicine 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/3827369.

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Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.

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Molina, Omar Franklin, Zeila Coelho Santos, Laura Martins, et al. "Differentiating occipital neuralgia from migraine and tension-type headache." Revista Neurociências 22, no. 3 (2014): 425–31. http://dx.doi.org/10.34024/rnc.2014.v22.8071.

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Objective. To establish differential diagnosis in patients presenting occipital neuralgia, tension-type headache, and migraine with aura. Method. We analyzed 32 patients with Occipital neuralgia (mean age=38.0; females=75%), 102 with tension-type headache (mean age=33.0; females=92.2%), and 16 with migraine without aura (mean age=37.0; females=56.3%). The specific symptoms of headaches were used in according to International Classification of Headache Disorders (ICHD) in patients with for craniomandibular disorders and bruxing behavior. Results. Occipital neuralgia group presented more nausea (78.1%; p=0.0001), vomiting (62.5%; p=0.0001), photophobia (71.8%; p=0.0001), throbbing (53.1%; p=0.0001), stabbing pain (78.1%; p=0.0001), severe pain (93.7%; p=0.0001), burning (68.8%; p=0.0001), and occipital nerve tenderness (100%; p=0.0001) than tension-type headache group. Occipital neuralgia group showed more stabbing (78.1%; p=0.0001), burning (68.8%; p=0.0005), and occipital nerve tenderness (100%; p=0.0001) than migraine without aura group. Migraine without aura group showed more vomiting (94%; p=0.03) and photophobia (100%; p=0.02) than occipital neuralgia group. Conclusions. Nausea, vomiting, photophobia, throbbing, stabbing, severer pain, a burning description and occipital nerve tenderness, better differentiated occipital neuralgia from tension-type headache. Stabbing pain, burning and occipital nerve tenderness, better differentiated occipital neuralgia from migraine without aura.

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Abd-Elsayed, Alaa. "Wireless Peripheral Nerve Stimulation at C2 and C3 to Treat Persistent Daily Headaches and Occipital Neuralgia." Pain Medicine Case Reports 5, no. 8 (2021): 409–11. http://dx.doi.org/10.36076/pmcr.2021.5.409.

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BACKGROUND: Headache is a very challenging condition to treat. We are presenting a unique approach for treating headache and occipital neuralgia that involves placing a wireless peripheral nerve stimulation system at the C2 and C3 levels. CASE REPORT: A 39-year-old man with a history of headache and occipital neuralgia resistant to several treatment modalities was treated with occipital nerve stimulation at the levels of C2 and C3. CONCLUSION: Peripheral nerve stimulation at the C2 and C3 levels is a unique approach for treating resistant headache and occipital neuralgia. KEY WORDS: C2, C3, headache, occipital neuralgia, peripheral nerve stimulation

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Kissoon, Narayan R., James C. Watson, Christopher J. Boes, and Orhun H. Kantarci. "Occipital neuralgia associates with high cervical spinal cord lesions in idiopathic inflammatory demyelinating disease." Cephalalgia 39, no. 1 (2018): 21–28. http://dx.doi.org/10.1177/0333102418769953.

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Background The association of trigeminal neuralgia with pontine lesions has been well documented in multiple sclerosis, and we tested the hypothesis that occipital neuralgia in multiple sclerosis is associated with high cervical spinal cord lesions. Methods We retrospectively reviewed the records of 29 patients diagnosed with both occipital neuralgia and demyelinating disease by a neurologist from January 2001 to December 2014. We collected data on demographics, clinical findings, presence of C2-3 demyelinating lesions, and treatment responses. Results The patients with both occipital neuralgia and multiple sclerosis were typically female (76%) and had a later onset (age > 40) of occipital neuralgia (72%). Eighteen patients (64%) had the presence of C2-3 lesions and the majority had unilateral symptoms (83%) or episodic pain (78%). All patients with documented sensory loss (3/3) had C2-3 lesions. Most patients with progressive multiple sclerosis (6/8) had C2-3 lesions. Of the eight patients with C2-3 lesions and imaging at onset of occipital neuralgia, five (62.5%) had evidence of active demyelination. None of the patients with progressive multiple sclerosis (3/3) responded to occipital nerve blocks or high dose intravenous steroids, whereas all of the other phenotypes with long term follow-up (eight patients) had good responses. Conclusions A cervical spine MRI should be considered in all patients presenting with occipital neuralgia. In patients with multiple sclerosis, clinical features in occipital neuralgia that were predictive of the presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, later onset of occipital neuralgia, and progressive multiple sclerosis phenotype. Clinical phenotype predicted response to treatment.

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Pietramaggiori, Giorgio, and Saja Scherer. "A guide for occipital neuralgia patients." Open Access Government 42, no. 1 (2024): 160–61. http://dx.doi.org/10.56367/oag-042-11381.

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A guide for occipital neuralgia patients Giorgio Pietramaggiori, MD, PhD and Saja Scherer, MD, from the Global Medical Institute, help us to understand occipital neuralgia in this detailed patient guide. Migraines are a heterogeneous cluster of diseases with the common denominator of headaches. Accompanying symptoms, such as nausea, visual disturbances, malaise, and extreme fatigue, can be as handicapping as the headaches themselves. Among migraines, occipital neuralgia stands as a condition that can significantly disrupt daily life for those afflicted. Occipital neuralgia is characterised by constant pain and pressure in the back of the head. It also manifests with intense, piercing irradiations in the posterior scalp, sometimes felt through the eyes. While its name might sound daunting, gaining a comprehensive understanding of occipital neuralgia is essential for both patients and non-affected individuals.

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Dhar, Sovan, Rajendra Sahoo, Zulfuqur Khan, Majumdar Das, and Dillip Parida. "Occipital neuralgia in lung carcinoma: A rare clinical scenario case report." Archive of Oncology 24, no. 1 (2018): 10–11. http://dx.doi.org/10.2298/aoo180330002d.

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Occipital neuralgia is an uncommon cause of pain over occipital region. When occipital nerves are affected due to osteogenic / vasculogenic / neurogenic causes it is manifested as a sharp shooting or stabbing type of pain over the occipital region of scalp, often progressing to involve the vertex and the temporal region as well. Use and withdrawal of variety of drugs result in headache. The role of any chemotherapeutic drug, as a causative agent for occipital neuralgia, has not been described in literature so far. We are reporting a rare case of occipital neuralgia precipitated while on combination chemotherapy regimen in lung carcinoma.

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Wang, Michael Y., and Allan D. O. Levi. "Ganglionectomy of C-2 for the treatment of medically refractory occipital neuralgia." Neurosurgical Focus 12, no. 1 (2002): 1–3. http://dx.doi.org/10.3171/foc.2002.12.1.15.

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Occipital neuralgia is a result of neuropathic pain transmission in the distribution of the greater occipital nerve. Because it is well anatomically localized, occipital neuralgia has been the focus of various surgical treatments. Ablation, decompression, and modulation of the C-2 nerve have all been described as effective treatments. The C-2 dorsal root ganglionectomy provides effective treatment for this disorder with a low incidence of unpleasant side effects. In this review the authors summarize the current treatment of occipital neuralgia.

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Kim, Min-hwa, I.-rang Nam, Mariah Kim, et al. "A Case Report of Occipital Neuralgia Treated with Acupuncture in the Occipital Nerve Area." Journal of Internal Korean Medicine 44, no. 6 (2023): 1327–36. http://dx.doi.org/10.22246/jikm.2023.44.6.1327.

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This case report presents the effectiveness of Korean medicine in the treatment of occipital neuralgia. The patient with occipital neuralgia was treated with acupuncture. Acupuncture treatment was administered to the occipital nerve area, which is commonly used in occipital nerve blocks by western medicine doctors. The severity of the symptoms was assessed daily using the Numerical Rating Scale (NRS) score of pain. The patient received outpatient treatment a total of 7 times, and only received acupuncture treatment each time. According to the patient, his symptoms decreased by about 90% two days after acupuncture treatment, and the frequency and duration of the symptoms also decreased. Seven days after all acupuncture treatments, the severity of pain was reduced from NRS 6 to NRS 0. The findings of this case report suggest that treatment with Korean medicine can be an effective option for treating occipital neuralgia. Acupuncture can be a good treatment method for occipital neuralgia, along with western drug treatment and occipital nerve block.

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Magown, Philippe, Rene Garcia, Ian Beauprie, and Ivar Mendez. "Occipital Nerve Stimulation for Intractable Occipital Neuralgia." Neurosurgery 62, no. 6 (2008): 1426. http://dx.doi.org/10.1227/01.neu.0000333534.08022.85.

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Jose, Anson, Shakil Ahmed Nagori, Probodh K. Chattopadhyay, and Ajoy Roychoudhury. "Greater Occipital Nerve Decompression for Occipital Neuralgia." Journal of Craniofacial Surgery 29, no. 5 (2018): e518-e521. http://dx.doi.org/10.1097/scs.0000000000004549.

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27

Sierra-Hidalgo, F., J. Ruíz, A. Morales-Cartagena, A. Martínez-Salio, J. de la Serna, and J. Hernández-Gallego. "Infiltrative cervical lesions causing symptomatic occipital neuralgia." Cephalalgia 31, no. 14 (2011): 1493–96. http://dx.doi.org/10.1177/0333102411418693.

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Background: Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported. Case reports: We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion. Discussion: We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.

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Rothner, A. David, Gerald Erenberg, and Robert P. Cruse. "Occipital Neuralgia in Adolescents." Cephalalgia 9, no. 10_suppl (1989): 266. http://dx.doi.org/10.1177/0333102489009s10142.

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Cesmebasi, Alper, Mitchel A. Muhleman, Paul Hulsberg, et al. "Occipital neuralgia: Anatomic considerations." Clinical Anatomy 28, no. 1 (2014): 101–8. http://dx.doi.org/10.1002/ca.22468.

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Joseph, Crystal, Anishinder Parkash, John Gallagher, Ahish Chitneni, and Hirsh Kaveeshvar. "Tourette’s Syndrome cervical dystonia induced occipital neuralgia remedied by peripheral nerve stimulation: A case report." Headache Medicine 14, no. 4 (2023): 230–34. http://dx.doi.org/10.48208/headachemed.2023.40.

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BackgroundDystonia is uncommon in Tourette’s syndrome, and occipital neuralgia secondary to Tourette's dystonia is more rare, affecting quality of life. Occipital peripheral nerve stimulation (PNS) is an excellent alternative by being adjustable and minimally invasive. Our case demonstrates occipital PNS as an effective option for refractory Tourette’s dystonia.Case PresentationA thirty-four-year-old male with poorly controlled Tourette’s cervical dystonia presented with severe occipital neuralgia. Various medications were prescribed including propranolol and amitriptyline, and bilateral third-occipital nerve rhizotomies and occipital nerve blocks were trialed. Distal nerve blocks at the occipital protuberance were most effective. Therefore, an occipital PNS trial was done, and a PNS was implanted with no complications. Upon follow-up, the patient reported drastic pain reduction.ConclusionOur case illustrates neuromodulation benefits for a rare presentation of refractory occipital neuralgia secondary to Tourette’s-related dystonia. Occipital PNS should be considered for refractory cases because it is safe, easy to implant, and effective.

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Vu, Tiffany, and Akhil Chhatre. "Cooled Radiofrequency Ablation for Bilateral Greater Occipital Neuralgia." Case Reports in Neurological Medicine 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/257373.

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This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy.

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Hazewinkel, Merel H. J., Leonard Knoedler, Katya Remy, Sierra Tseng, William G. Austen, and Lisa Gfrerer. "Surgical Outcomes Following Distal Nerve Decompression in Patients With Trigeminal Neuralgia." Plastic and Reconstructive Surgery - Global Open 13, no. 2 (2025): e6507. https://doi.org/10.1097/gox.0000000000006507.

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Background: Patients with headache disorders may present with compression of distal trigeminal nerve branches as well as other head and neck nerve branches such as the occipital nerves. In addition, a coexisting diagnosis of trigeminal neuralgia of proximal origin may be present. This overlap in diagnoses complicates treatment. Therefore, this study aimed to investigate the therapeutic effects of distal nerve decompression surgery in patients with coexisting trigeminal neuralgia from a proximal origin. Methods: The charts of 1112 patients who underwent screening for nerve decompression surgery were retrospectively reviewed. Patients with trigeminal neuralgia who underwent nerve decompression surgery were included. Data regarding preoperative and postoperative pain characteristics were collected. Results: Seventeen (1.5%) patients met the inclusion criteria and underwent nerve decompression. Fifteen patients (56%) underwent occipital decompression (13 greater occipital nerve decompressions, and 10 lesser occipital nerve decompressions), 5 patients (19%) underwent frontal decompression (supraorbital nerve/supratrochlear nerve decompression), and 6 patients (22%) underwent temporal decompression (4 zygomaticotemporal decompressions and 2 auriculotemporal nerve decompressions). Among the patients who underwent occipital decompression, 11 (73%) patients reported ≥80% pain relief, 1 (6.7%) patient reported ≥50% pain relief, and 3 (20%) patients reported ≤20% pain relief. For frontal and/or temporal decompression, only 2 (28%) patients achieved substantial pain relief (100% and 50%), whereas 5 (71%) patients experienced ≤20% pain relief. Conclusions: Our results demonstrate that occipital nerve decompression is an effective treatment for alleviating occipital neuralgia in individuals with coexisting proximal trigeminal neuralgia. However, the outcomes of frontal and temporal decompression were less favorable.

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Trescot, Andrea, Gabor Racz, and Laszlo Nagy. "Suboccipital Decompression for Occipital Neuralgia." Journal of Spine and Neuroscience 1, no. 1 (2017): 4–11. http://dx.doi.org/10.14302/issn.2694-1201.jsn-17-1527.

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Cervicogenic headaches are a significant cause of head and neck pain, and occipital neuralgia is a common component of these cervicogenic headaches. Occipital injections are commonly performed at the occipital ridge, but this site does not address more proximal entrapments of the nerve in the suboccipital region. Because of the potentially dangerous structures in this region, clinicians have tended to avoid the suboccipital region, despite the pathologies seen in this region. This article discusses the pathology of the region, the alternative techniques, and the novel interventional approach developed for this region, specifically the “Stealth” approach of occipital decompression.

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Zipfel, Jonathan. "Ultrasound-Guided Intermediate Site Greater Occipital Nerve Infiltration: A Technical Feasibility Study." Pain Physician 7;19, no. 7;9 (2016): E1027—E1034. http://dx.doi.org/10.36076/ppj/2016.19.e1027.

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Background: Two studies recently reported that computed tomography (CT) guided infiltration of the greater occipital nerve at its intermediate site allows a high efficacy rate with long-lasting pain relief following procedure in occipital neuralgia and in various craniofacial pain syndromes. Objective: The purpose of our study was to evaluate the technical feasibility and safety of ultrasound-guided intermediate site greater occipital nerve infiltration. Study Design: Retrospective study. Setting: This study was conducted at the imaging department of a 1,409 bed university hospital. Methods: Local institutional review board approval was obtained and written consent was waived. In this retrospective study, 12 patients suffering from refractory occipital neuralgia or craniofacial pain syndromes were included between April and October 2014. They underwent a total of 21 ultrasound-guided infiltrations. Infiltration of the greater occipital nerve was performed at the intermediate site of the greater occipital nerve, at its first bend between obliqus capitis inferior and semispinalis capitis muscles with local anestetics and cortivazol. Technical success was defined as satisfactory diffusion of added iodinated contrast media in the fatty space between these muscles depicted on control CT scan. We also reported first data of immediate block test efficacy and initial clinical efficacy at 7 days, one month, and 3 months, defined by a decrease of at least 50% of visual analog scale (VAS) scores. Results: Technical success rate was 95.24%. Patients suffered from right unilateral occipital neuralgia in 3 cases, left unilateral occipital neuralgia in 2 cases, bilateral occipital neuralgia in 2 cases, migraine in one case, cervicogenic headache in one case, tension-type headache in 2 cases, and cluster headache in one case. Block test efficacy was found in 93.3% (14/15) cases. Clinical efficacy was found in 80% of cases at 7 days, in 66.7% of cases at one month and in 60% of cases at 3 months. No major complications were noted. Limitations: Some of the limitations of our study include that it represents a single institution. The low number of infiltrations included in this study, for this guidance procedure, is another bias. Conclusions: This ultrasound-guided infiltration technique appears to be feasible, safe, nonionizing, and fast when targeting the greater occipital nerve in its intermediate portion. This imaging guidance modality should be used in routine clinical practice. Key words: Greater occipital nerve, infiltration, ultrasound guidance, corticosteroids, occipital neuralgia, craniofacial pain syndrome

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Nagel, Vanesa, Lucas Bonamico, and María T. Goicochea. "Headache with occipital neuralgia phenotype: Report of four cases." Cephalalgia Reports 4 (January 1, 2021): 251581632110398. http://dx.doi.org/10.1177/25158163211039800.

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Background: The International Headache Society defines Occipital neuralgia as an unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp, in the distribution(s) of the greater, lesser and/or third occipital nerves. The most common pain trigger in this area result from chronically contracted muscles. Different aetiologies of headache with occipital neuralgia phenotype have been described. Case: We report four cases in which pain with occipital neuralgia phenotype was the initial symptom of a clivus chordoma; a para-pharyngeal carcinoma; a vertebral dissection; and a brachial plexitis due to zoster. Conclusion: A detailed anamnesis and physical examination should be performed in these patients. If during follow up atypical finding appears, we recommend head and neck gadolinium-enhanced MRI and biochemistry to exclude secondary causes.

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Graff-Radford, Steven B., Bernadette Jaeger, and John L. Reeves. "Myofascial Pain May Present Clinically as Occipital Neuralgia." Neurosurgery 19, no. 4 (1986): 610–13. http://dx.doi.org/10.1227/00006123-198610000-00017.

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Abstract Three case presentations illustrate that the clinical signs and symptoms of occipital neuralgia may be produced by myofascial pain. Assessment of myofascial trigger points is needed before making a diagnosis of occipital neuralgia. Myofascial trigger points can be effectively treated with minimally invasive procedures, thereby avoiding irreversible surgical interventions.

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Robinson, Isabel S., Ara A. Salibian, Allyson R. Alfonso, Lawrence J. Lin, Jeffrey E. Janis, and Ernest S. Chiu. "Surgical Management of Occipital Neuralgia." Annals of Plastic Surgery 86, no. 3S (2021): S322—S331. http://dx.doi.org/10.1097/sap.0000000000002766.

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Goicochea, MT, C. Romero, and JA Leston. "Occipital Neuralgia With Cervical Myelitis." Cephalalgia 28, no. 5 (2008): 567–68. http://dx.doi.org/10.1111/j.1468-2982.2008.01543.x.

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Takano, Akemi, Shin'ichi Miyao, and Jun Teramoto. "Clinical Analysis of Occipital Neuralgia." Cephalalgia 11, no. 11_suppl (1991): 348. http://dx.doi.org/10.1177/0333102491011s11186.

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Gevirtz, Clifford. "Pain Management for Occipital Neuralgia." Topics in Pain Management 24, no. 5 (2008): 1–6. http://dx.doi.org/10.1097/01.tpm.0000341977.04048.4a.

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Janjua, M. Burhan, Sumanth Reddy, Tarek Y. El Ahmadieh, et al. "Occipital neuralgia: A neurosurgical perspective." Journal of Clinical Neuroscience 71 (January 2020): 263–70. http://dx.doi.org/10.1016/j.jocn.2019.08.102.

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Mitsias, Peter. "Surgical Therapy for “Occipital Neuralgia”." Cephalalgia 13, no. 5 (1993): 306. http://dx.doi.org/10.1046/j.1468-2982.1993.1305306-2.x.

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Calabrò, Rocco Salvatore, and Placido Bramanti. "Occipital Neuralgia Responding to Palmitoylethanolamide." Headache: The Journal of Head and Face Pain 57, no. 10 (2013): E23—E24. http://dx.doi.org/10.1111/head.12136.

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Post, Alexander F., Prithvi Narayan, and Regis W. Haid. "Occipital neuralgia secondary to hypermobile posterior arch of atlas." Journal of Neurosurgery: Spine 94, no. 2 (2001): 276–78. http://dx.doi.org/10.3171/spi.2001.94.2.0276.

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✓ The authors report on the management of occipital neuralgia secondary to an abnormality of the atlas in which the posterior arch was separated by a fibrous band from the lateral masses, resulting in C-2 nerve root compression. The causes and treatments of occipital neuralgia as well as the development of the atlas are reviewed.

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Rio, Beatriz Ballesteros-Del, Adrian Ares-Luque, Javier Tejada-Garcia, and Alberto Muela-Molinero. "Occipital (Arnold) Neuralgia Secondary to Greater Occipital Nerve Schwannoma." Headache: The Journal of Head and Face Pain 43, no. 7 (2003): 804–7. http://dx.doi.org/10.1046/j.1526-4610.2003.03142.x.

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Dewan, Michael C., Saniya S. Godil, Stephen K. Mendenhall, Clinton J. Devin, and Matthew J. McGirt. "C2 Nerve Root Transection During C1 Lateral Mass Screw Fixation." Neurosurgery 74, no. 5 (2014): 475–81. http://dx.doi.org/10.1227/neu.0000000000000306.

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Abstract BACKGROUND: Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. OBJECTIVE: To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws. METHODS: All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms. RESULTS: A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being “bothered” by it. All patients with occipital neuralgia after C2 sparing reported being “bothered” by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016). CONCLUSION: C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization.

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Alfieri, Alex, and Christian Strauss. "Familial occipital neuralgia with sporadic nervus intermedius neuralgia (NIN)." Journal of Headache and Pain 12, no. 6 (2011): 657. http://dx.doi.org/10.1007/s10194-011-0380-y.

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Yi, Ho Jun, Jae Taek Hong, Jong Beom Lee, et al. "Analysis of Risk Factors for Posterior C1 Screw-Related Complication: A Retrospective Study of 358 Posterior C1 Screws." Operative Neurosurgery 17, no. 5 (2019): 509–17. http://dx.doi.org/10.1093/ons/opz068.

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Abstract BACKGROUND Although C1 screw fixation is becoming popular, only a few studies have discussed about the risk factors and the patterns of C1 screw complications. OBJECTIVE To investigate the incidence of C1 screw complications and analyze the risk factors of the C1 screw complications. METHODS A total of 358 C1 screws in 180 consecutive patients were analyzed for C1 screw complications. Screw malposition, occipital neuralgia, major complications, and total C1 screw complications were analyzed. RESULTS The distribution of C1 screw entry point is as follows: inferior lateral mass, 317 screws (88.5 %); posterior arch (PA), 38 screws (10.7 %); and superior lateral mass, 3 screws (0.8 %). We sacrificed the C2 root for 127 screws (35.5 %). C1 instrumentation induced 3.1 % screw malposition, 6.4 % occipital neuralgia, 0.6 % vascular injury, and 3.4 % major complications. In multivariate analysis, deformity (odds ratio [OR]: 2.10, P = .003), traumatic pathology (OR: 4.97, P = .001), and PA entry point (OR: 3.38, P = .001) are independent factors of C1 screw malposition. C2 root resection can decrease the incidence of C1 screw malposition (OR: 0.38, P = .012), but it is a risk factor of occipital neuralgia (OR: 2.62, P = .034). Advanced surgical experience (OR: 0.09, P = .020) correlated with less major complication. CONCLUSION The incidence of C1 screw complications might not be uncommon, and deformity or traumatic pathology and PA entry point could be the risk factors to total C1 screw complications. The PA screw induces more malposition, but less occipital neuralgia. C2 root resection can reduce screw malposition, but increases occipital neuralgia.

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Agnija, Taluma, and Griskjans Zans. "Occipital Neuralgia Caused by an Intramuscular Lipoma. A Case Report." Acta Chirurgica Latviensis 18, no. 1 (2020): 54–55. http://dx.doi.org/10.2478/chilat-2020-0014.

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SummaryOccipital neuralgia is a type of chronic headache disorder in the dermatomes of the greater or lesser occipital nerve. (7) We describe here a rare case of occipital neuralgia caused by an intramuscular lipoma. A 45 year-old man presented with troublesome pain in the occipital area with 3 x 2 cm palpable mass in the right occipital region. Patient was treated by a neurologist. The X ray for cervical vertebrae and computed tomography was performed.Computed tomography revealed a mass reminding intramuscular lipoma. Surgical management was indicated. During the operation stretching of the lesser occipital nerve was detected. After resection of lipoma on postoperative follow – up, the patient reported that the pain had resolved. During the histopathological examination, lipoma was confirmed.

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Salmasi, Vafi, Oludare O. Olatoye, Abdullah Sulieman Terkawi, Jennifer M. Hah, Einar Ottestad, and Matthew Pingree. "Peripheral Nerve Stimulation for Occipital Neuralgia." Pain Medicine 21, Supplement_1 (2020): S13—S17. http://dx.doi.org/10.1093/pm/pnaa083.

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Abstract Background Chronic headaches are the second most prevalent disease and second most common cause for years lived with disability worldwide. Occipital neuralgia can cause headaches or be present in addition to other more prevalent causes of headache. If these headaches fail to respond to conservative and pharmacological therapy, physicians proceed to more invasive treatments, starting with infiltration of the greater occipital nerve with local anesthetic with or without corticosteroids, followed by nerve ablation or stimulation. Occipital nerve stimulation gained more popularity as the technology improved and more pain physicians received training on interventional procedures. Methods In this manuscript, we are presenting our experience with ultrasound-guided implant of occipital nerve stimulators using peripheral nerve stimulator systems. After confirming appropriateness of treatment by a successful occipital nerve block (i.e., resulting in &gt;50% relief in patients’ pain intensity), we implanted five stimulator systems in three patients (two bilateral). Results We followed these patients for an average of eight months, and the average pain reduction was ∼50%. We did not observe any adverse events during or immediately after surgery. One patient developed an adverse reaction to the adhesive of the battery transmitter, but it was not severe enough to stop her from using the stimulator. Conclusions Considering the ease of implant and minimal side effects, implant of peripheral nerve stimulators to stimulate the occipital nerve is a promising treatment modality for patients with chronic headache who present with features of occipital neuralgia. However, wider use of this treatment modality is subject to further studies.

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