Jonathan Aarons M.D.

Tired of Chronic Pain?

Occipital Neuralgia

1. What is Occipital Neuralgia?

Occipital neuralgia is a type of headache. The pain from the headache follows the distribution of the occipital nerve, which originates in the back of the head. It can radiate from the back of the head up to the top of the scalp or along the side of the head. The pain is described as burning or throbbing. It can be limited to one or both sides of the head. The pain can also be shocking or shooting in nature. Occasionally, the headache can also radiate to the neck or temple or be felt behind the eye.

2. How do you diagnose Occipital Neuralgia?

Your physician makes the diagnosis with a thorough history and physical examination. Abnormalities on the neurological exam may point to other causes. Often there are tender areas of the scalp overlying the occipital nerve. Sometimes a CT scan or MRI may be necessary to rule out other causes. Occasionally, occipital neuralgia can be mistakenly diagnosed as fibromyalgia or cervical disc disease. A diagnostic occipital nerve block may be crucial in making the diagnosis.

3. What is the treatment for Occipital Neuralgia?

The treatment of occipital neuralgia begins with conservative management. Initially, we start with a trial of medications such as nonsteroidal anti-inflammatory drugs. Tricyclic antidepressants and anticonvulsants are also useful to suppress irritable nerve impulses that may cause the pain. Mild narcotics may be useful on a limited basis. Physical therapy, massage, acupuncture, heat are useful modalities. Occipital nerve block is used for both the diagnosis and treatment of occipital neuralgia. It is one of the simplest and easiest methods both to diagnose and treat this problem. The area of the nerve is injected by the pain management doctor or interventional anesthesiologist with a dilute solution of a local anesthetic with or without a corticosteroid. This injection usually results in almost complete relief in cases of occipital neuralgia. The duration of the relief is variable. Although permanent relief is possible, several injections may be necessary or long term relief may not be possible with injections alone.

4. How is the injection done?

First, you will have a consultation with the pain specialist, usually an interventional anesthesiologist. Once he determines that you are a candidate for the injection, he will schedule your procedure. If you are taking any medications, such as blood pressure medications or blood thinners, you will need to discuss this with the doctor to determine whether or not to continue with them prior to the procedure. If you are diabetic, the doctor will need to know that as this injection may cause a rise in blood sugar several days after the procedure. The injection is usually quick, only several minutes for each area. The doctor locates the painful area. The overlying skin is cleansed with alcohol. A very thin needle is placed in the painful area and a dilute solution of a local anesthetic (numbing medication) is injected and the needle is then removed. Some patients have more than one painful area that may need to be injected.

5. What should I expect after the procedure?

Immediately after the procedure, you may feel that your pain is less. This is due to the local anesthetic. After the local anesthetic has worn off in several hours, the pain will return. You may have some slight soreness at the injection site for several days due to the irritation from the needle. The medication itself may take several days to work. The duration of pain relief is different for each patient. For some patients, the pain relief may last from several days to as long as several months.

6. How many injections do I need?

You may get significant pain relief from the first injection and a second injection may not be necessary. If the first injection does not completely relieve your pain, a second may then be given. Many times injections are given in a series, usually no more than three injections within six months.

7. What are the risks of the injection?

Generally speaking, this is a simple and safe procedure. The most common side effect is pain at the site where the needle was inserted. This should resolve within several days. Bleeding and infection are a risk of any injection at any site.

8. Should I get the injection?

That decision can only be made after you see the interventional anesthesiologist. He will discuss all of your options for treatment including injections. After the evaluation, he will determine if a occipital neuralgia is the likely source of your pain and if you are a candidate for the procedure.