Occipital Neuralgia is characterized by pain in the suboccipital region and in the back of the head, radiating upward. A large number of patients have muscle tension headaches in the same distribution, but a few of these patients have true neuralgic pain.
Most patients with occipital neuropathy have no discernable structural abnormality. Know causes of neuralgic pains include arthitic spurs at the upper cervical levels, trauma to to the greater or lesser occitpital nerves, or trauma to the cervical nerves. It is very rare to observe a tumor involving the C2 or C3 nerve roots.
Occipital Neuralgia is characterized by continuous aching and throbbing pain on which shock like jabs can be superimposed. The pain starts at the base of the neck and radiates upward over the back of the skull. Pressure or muscle spasm over the occipital area can trigger an attack. Sometimes pain can be felt behind the eyes. Some patients can have migraine like symtoms and some may note sensory changes in the back of the neck and skull area.
The region of the pain clearly establishes the diagnosis. Tender areas at the base of the skull are common. Positve neurologic findings may indicate a CT scan, but structural lesions that can be identified on X-Ray are rare.
If there is a structural lesion, treatment is aimed at its cause. If the pains resemble those of tic douloreux, a trial of anticonvulsants may be worthwhile. If they resemble those of atypical facial pain, a tricyclic antidepressant and a phenothiazine may be tried. Local nerve blocks are able to establish the diagnosis and may result in prolonged relief. Controlled studies of a wide variety of treatments are lacking.
Appointments can be made by calling: 931.840.4333
Thank you. By Dr. Bowers, at the Pain Institute of Tennessee.
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