What is Occipital Neuralgia?

Occipital neuralgia (ON) affects the occipital nerves, which start at the top of the top part of the spinal cord and go up the back of the skull. Pain in this area is often due to inflammation or injury of the occipital nerves. 

ON affects 3.2 out of 100,000 people per year, according to one report by the American Migraine Foundation. Occipital nerve pain is often confused with different types of headaches, especially migraines because the symptoms can appear similar. However, the treatment for occipital neuralgia is much different than treatments for migraines and headaches. Therefore, it is important for people to get a correct diagnosis for their head pain.

Symptoms

Head pain associated with the occipital nerves is sudden, jabbing, piercing, burning, and/or throbbing. Pain originates at the base of the skull and radiates toward the sides of the head, as well as the front and back. A person may also feel pain behind the eyes, in the upper part of the neck, and behind the ears.  

Additional symptoms of ON include:

• Light sensitivity
• Dizziness and lightheadedness
• Vertigo (a sensation of spinning)
• Tender scalp
• Slurred speech
• Nausea and/or vomiting
• Tightness and/or stiffness in the neck
• Dental pain
• Blurry vision
• Nasal congestion
• Tinnitus (ringing in the ears)

Symptoms of ON can be mild or severe, and they vary from person to person. The pain associated with ON can be very intense, which is why some people confuse this pain with that of a migraine. These pain episodes can last for minutes or hours, but the tenderness in the nerves and other symptoms may continue long past the pain episodes.

Causes

Occipital neuralgia begins in the occipital nerves and it is often caused by inflammation of the nerves or an injury to them. Inflammation and injury are direct causes of ON, but they don’t explain what exactly has caused the inflammation or injury. Researchers have speculated on more specific and direct causes for ON, including injury to the neck or head, arthritis conditions, diabetes, tumors, and infections.

Injuries

Trauma to the back of the head is one of the most common causes of ON. This could be anything from a fall or car accident or even a sports injury. Injuries that inflame and pinch the nerves of the neck can also cause ON pain and symptoms.

Stressed Nerves

ON affects the nerves that run up the neck. People who constantly sit with their head in forward and/or downward positions, such as those who do computer jobs, can end up with strained muscles in their necks. Nerve compression can also affect people who do repetitive manual jobs as well.

Arthritic Conditions

Several types of arthritis affect the cervical spine, including osteoarthritis and rheumatoid arthritis (RA). Much like other joints in the body, the spine can deteriorate with age or due to prolonged inflammation, as is the case with RA and other types of inflammatory arthritis.

Degeneration from arthritic conditions causes the cervical spine—the uppermost part of the spinal column—to break down and become stiff with time. This can eventually cause pressure and strain on the occipital nerves.

Diabetes

Those who suffer from diabetes have an increased risk for ON. This is because diabetes causes neuropathy, or inflammation of the nerves themselves, including the occipital nerves.

Tumors and Infections

Tumors and infections are rare causes of ON. Tumors of the cervical spine can put pressure on the occipital nerves. Infections, on the other hand, can lead to trauma of the occipital nerves. Both of these causes can be serious, so it is important for people to talk to their healthcare providers if they find a lump on their neck or throat, or if they have a persistent fever with trouble swallowing and a sore throat that isn’t going away.

It is important to note that researchers have not confirmed any direct or specific causes of ON, and possible causes are not well understood. Further, it is also possible to have symptoms of ON with no related conditions or history of injury or trauma.

Diagnosis

A diagnosis of ON can be made with a physical exam and medical history. The physical exam includes the healthcare provider pressing on the occipital nerves to see if the pain is reproduced. If pain is experienced, a diagnosis of occipital neuralgia is considered.

Diagnostic testing, including MRIs, CT scans, X-rays, and blood work can help to determine a specific cause leading to symptoms. A nerve block can also help with diagnosis. A shot is usually given in the occipital area to numb the nerve. If pain relief is experienced from the injection, a patient is likely suffering from ON.

Treatment

Anti-epileptic medications and tricyclic antidepressants may help prevent symptoms of ON in some people. 

Other treatments for pain and other symptoms of ON include:

• Nerve blocks
• Pulsed radiofrequency
• Physical therapy
• Surgery

Warm compresses and massages can help relax and release pressure from the occipital nerves. NSAIDs can help bring down inflammation in the nerves while muscle relaxers may work to relax the nerves. Nerve block injections may help to prevent pain associated with ON. A physical therapist can teach individuals exercises to help prevent occurrences and for getting through painful and symptomatic episodes of ON.

Pulsed radiofrequency is a technique that stimulates the occipital nerves and prevents them from sending pain signals. This treatment is safe and has not been known to cause damage to nerves or tissues. While the research is limited, studies have shown pulsed radiofrequency to be a promising treatment that can reduce pain, improve quality of life, and reduce the amount of pain medication needed to manage ON.

Surgery is generally a last resort treatment, however, a surgical procedure called occipital release can reduce and even eliminate nerve pressure.

A Word From Verywell

Occipital neuralgia is rarely a serious condition. Nonetheless, it is still important to tell your healthcare provider about any severe or ongoing pain to rule out spinal cord problems, cancerous tumors, infections, or other life-threatening conditions.