Occipital Neuralgia

What is Occipital Neuralgia?

Occipital neuralgia is an irritation and/or damage to the greater or lesser occipital nerve. In 90% of cases the greater occipital is the primary nerve irritated, and only 10% of cases had the lesser occipital nerve as the cause.

When these structures are damaged it can result in a bilateral (on both sides) ache, throbbing or burning pain that begins at the base of the skull and comes over the scalp. This can sometimes occur in a ram’s horn pattern going from the base of the neck in a circle to in front of the ear and near the eye. It is likely to occur after there is a trauma to the area such as a bend and twist of the neck.

In addition to the symptoms above there can be pain in the upper neck that can be associated with nausea and sensitivity to light. There can be a positive tunnel’s sign – reproduction of neurological tingling and numbness, after there is palpation o f these nerves. Other symptoms can include tinnitus (ringing of the ears), dizziness and blurred vision, scalp tenderness and headaches.

Assessment:

When you see an osteopath physical examination will include examination of the neck to identify tight muscles at the mase of the skull, range of motion, neurological testing and identification of referral pain. Tests that identify any possible ligament damage, facet irritation and nerve irritation will also be performed. These tests may aggravate your symptoms however that is necessary in order to pinpoint what is going on.

To rule out any damage to the nerves of the skull and those that innervate the arms neurological strength and sensation testing will be performed. Outcome measures such as the neck disability index may be performed and a referral to the patient’s general practitioner for an MRI/CT and possible nerve block may also be required.

Treatment:

Conservative treatment includes manual therapy such as osteopathy, massage and physiotherapy that focuses on decreasing tight muscle, neuropathic pain and referral.

Our osteopathic practitioners can use a variety of techniques including inhibition, soft tissue, mobilisation, manipulation as well as techniques from osteopathy in the cranial field – something which we specialise in and is performed by no other modality. It is common after treatment to experience some aggravated symptoms however this should subsite within one to two days.

The application of heat and steroids can be used to temporarily manage pain levels and medication is typically prescribed by your doctor. Over the counter anti-inflammatory medications can also have an effect. It is advised that these methods are used regularly and over a shorter period of time.

Other conservative interventions include nerve blocks which last a period of three to four months can also be affective as they contain anaesthetic and anti-inflammatory medications.

Pulsed radiofrequency uses a radiology machine as a treatment mechanism. The theory is that by exposing the nerve to many high voltage short duration pulses can decrease the nerve sensation and pain. Stimulation of the nerve using a neurostimulator can also block nerve sensation and decrease pain.

If none of these methods are effective, then occipital release surgery is recommended. This surgery takes 2-3 hours while the patient is under general anaesthesia with a recovery period of two to three weeks. However, risks of this surgery include permanent numbness of the scalp.

If you are experiencing any of these symptoms and wish to see an osteopath for conservative treatment you’re welcome to book an appointment at eclipse health and osteopathy today. Call 5613 3505 or book through our website.

References

Dougherty, C. (2014, April 16). Occipital Neuralgia. Current Pain and Headache Reports 18, 411. https://doi.org/10.1007/s11916-014-0411-x

Hammond, S.R. and Danta, G. (1978). Occipital Neuralgia. Clinical and Experimental Neurology, 15. Pp 258-270. Occipital neuralgia – PubMed (nih.gov)

John Hopkins Medicine, (2022). Occipital Neuralgia. John Hopkins Medicine. Occipital Neuralgia | Johns Hopkins Medicine

London Pain Clinic, (2022). Nerve Pain – Occipital Neuralgia. London Pain Clinic. Nerve Pain – Occipital Neuralgia – London Pain Clinic

London Pain Clinic, (2022). Occipital Neuralgia. London Pain Clinic Occipital Neuralgia – London Pain Clinic

Marks, H., (2020, July 23). Occipital Neuralgia. WebMD. Occipital Neuralgia: Symptoms, Causes, Diagnosis, Treatments, and More (webmd.com)