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Occipital Neuralgia

Occipital neuralgia, also referred to as C2 neuralgia and in rare cases called Arnold’s neuralgia, is a medical condition accompanied by chronic pain experienced behind the eyes, back of the head and in the upper neck. These are the areas corresponding to locations of greater and lesser occipital nerves. The occipital artery which is wrapped around the nerve and supplies blood to it is also believed to be involved in occipital neuralgia. The condition is sometimes accompanied by diminished sensation experienced in the affected areas.

Signs and Symptoms of Occipital Neuralgia

The cardinal symptom of occipital neuralgia is a chronic headache; this pain is commonly located over the top, or in the back and around the head, and in some cases the pain might be experienced around the eye or up to the eyebrow. Because the symptoms of occipital neuralgia can mimic the symptoms of various conditions there is a high probability of misdiagnosis. In most cases this condition is mistaken for a migraine or a tension-type headache, which leads to failure of treatment attempts. Another significant symptom experienced by sufferers of occipital neuralgia is sensitivity to light also referred to as photophobia especially during the headaches.

This condition is characterized by intense pain that starts in the back of the head and the upper neck. In most cases the pain is experienced on one side, albeit it can occur on both sides in cases where both occipital nerves are affected by the condition. In addition, the experienced pain might be radiated towards the eye due to the following of the occipital nerve path. Patients of occipital neuralgia might experience blurred vision as the pain moves towards or near the eye.

The pain associated with neuralgia is described by patients as a shooting, sharp, electric shock, zapping, or stabbing pain.  The pain bouts are inconsistent but some patients have reported frequency depending on the nerve damages. The duration of the pain varies with each period the symptoms are experienced. The pain can last for a few seconds and can be as severe as almost continuous for some patients. The condition can last for a few hours or a number of days. Some of the other occipital neuralgia symptoms can include:

  • Pain experience on one or on both sides of the head
  • Sensitivity to light (photophobia)
  • Sensitivity to sound (phonophobia)
  • Pain experienced behind the eye
  • Burning, aching, and throbbing pain emanating from the base of the head and moves to the scalp
  • Tender scalp
  • Difficulty with coordination and balance
  • Nausea and/vomiting
  • Slurred speech
  • Pain when neck is in motion

Causes of Occipital Neuralgia

Occipital neuralgia is a result of damages to the occipital nerves. There are different ways through which the damage can occur including trauma – mostly concussive, repetitive neck contraction, extension or flexion, physical stress on the occipital nerve, and medical complications such as a benign tumor of the bone. CSF leak is another possible but rare cause of occipital neuralgia with another cause being Radio Frequency nerve ablation. In rare cases, the occipital neuralgia might occur as a symptom of some spine cancers metastasis. The following are some of the parts that have the potential to cause injury emanating from compression:

  • The antlantoaxial ligament as the dorsal ramus emerges
  • The space between C1 and C2 vertebral bones
  • Superficial side of semispinalis capitis, in the region of where the risk is posed by nerve piercing muscle and its fascia.
  • The deep side of the semispinalis capitis where piercing may involve the muscle itself or its fascia.
  • The deep of the superficial turn surrounding the inferiolateral border of obliquus capitis inferior muscle and its fascia.
  • The deep side of trapezius where the nerve enters the muscle

Differential diagnosis

Occipital pain is experienced in different headaches and migraine and this is what leads to the misdiagnosis of occipital neuralgia. There is a significant overlap between migraine and occipital neuralgia in matters related to occipital tenderness, severity and the similar response to nerve blocks. By definition, migraine pain will last longer than the pain exercised by occipital neuralgia sufferers. Other primary headaches such as cluster headache might have occipital tenderness but typically have symptoms which might not be present in occipital neuralgia.

Diagnosis of Occipital Neuralgia

Patients who suspect that they have occipital neuralgia should immediately seek medical attention. Diagnosis is mostly through medical history questions and information about any past injuries. In cases where the physician feels as if the condition is not typical, there will be blood tests or MRI scans. Some physicians might administer anesthetic nerve block to test if it relieves pain: if the nerve block works successfully, then the pain is likely to be emanating from occipital neuralgia.

It is important that proper diagnosis is done for the treatment to work. As aforementioned, most cases are misdiagnosed and others remain untreated because occipital neuralgia is characterized by symptoms which are common in a number of other conditions. Most occipital neuralgia patients are given prescription medication aimed at managing migraines and their pain is not relived as expected.

Treatment

After proper diagnosis, the symptoms of occipital neuralgia can be medically dealt with or treated in a number of ways. Medical science has availed a various treatment methods which are non-invasive and this includes alternative treatments. Some of the options include chiropractic manipulation, acupuncture, osteopathic manipulation, occupational therapy, massage, rest, physical therapy, heat, anti-convulsant medication, antidepressant medication, anti-inflammatory medication, migraine prophylaxis medication, naprapathic treatment, and opioid & nonopioid analgesia.

There are other alternative treatment methods that might be used in the treatment of occipital neuralgia including peripheral nerve stimulation, local nerve block, phenol injections, Occipital Cryoneurolysis, rhizotomy, and steroids.

Due to the similarity of the symptoms of occipital neuralgia and other conditions, it is important that patients seek medical attention from qualified medical practitioners who have extensive knowledge in medical conditions in this line. It is only when proper diagnosis and treatment directions are followed that the pain might be relieved and the condition successfully managed.

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