Occipital neuralgia is a craniofacial pain syndrome where the occipital nerves that supply sensation to your scalp are injured or inflamed. You can experience shooting, stabbing pain behind at the base of your skull to the top of your head and behind your eyes. There are many treatments that help reduce the pain from occipital neuralgia. Read on to learn more about how a neurologist can help you stop your scalp pain.
Causes of Occipital Neuralgia
The occipital nerve consists of C2 and C3 nerve roots in your cervical spine and exits the base of your skull to provide sensation to your scalp. There are 2 main nerves, the greater occipital nerve (GON) and lesser occipital nerve (LON).
There are many causes for occipital neuralgia resulting in compression or irritation of the occipital nerve. The GON (90%) is usually more affected than the LON (10%).
- Osteoarthritis of the upper cervical spine
- Cervical spine disc disease
- Muscle spasm
- Head or neck injury
- Blood vessel compression
- Giant cell arteritis
- Multiple sclerosis
- C2 myelitis
- Schwannoma
Signs and Symptoms of Occipital Neuralgia
The pain from occipital neuralgia can be continuous burning, throbbing pain with periods of shocking, shooting pain in the scalp on the back of your head. The pain can also travel behind your eyes. Your scalp can feel numb or tingling sensation. You may have tenderness at the base of your skull.
Because of the complicated nerve connections, some people can experience visual changes (67%), tinnitus (33%), dizziness (50%), nausea (50%), and nasal congestion (17%). The pain and associated symptoms can be similar to migraine headaches or cluster headaches.
Diagnosis
There is no single test to diagnose occipital neuralgia. Diagnosis of occipital neuralgia is by a history and examination performed by your neurologist. Scalp pain or tingling may be produced by applying light pressure on your occipital nerve. Your neurologist may order an MRI or CT scan and lab work to exclude other causes of your occipital neuralgia.
Treatments for Occipital Neuralgia
The treatment for occipital neuralgia can range from non-surgical options to surgery that you can discuss with your neurologist.
Non-surgical treatment can start with heating pads and physical therapy or massage therapy. Oral medications can also be added and includes anti-inflammatory medications, muscle relaxants, or anti-convulsants and anti-depressants. Local anesthestic with/without steroid or botulinum toxin injections may provide temporary symptomatic relief. Pulsed radiofrequency treatments have also shown help briefly.
Surgical treatment may be an option if you do not get adequate symptom relief from medical therapies. Options include neurolysis, occipital nerve stimulation, spinal cord stimulation, and C2-3 ganglionectomy. Your neurologist can refer you to a neurosurgeon to discuss more surgical options.