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Occipital Neuralgia

Occipital Neuralgia is an injury or inflammation of the occipital nerves, the nerves that flow along the scalp. This results in an intense, piercing, throbbing, shock-like, and chronic pain in the upper neck, back of the head, and behind the ears. Occipital neuralgia is considered among the most severe forms of neuropathic pain.

A man with occipital neuralgia holding his head

Symptoms of occipital Neuralgia

People with occipital Neuralgia typically experience discomfort along the spine where it crosses the scalp and pain along the back of the neck and head. It is basically a type of nerve pain that can manifest the following symptoms:

  • Neck Pain and discomfort in the back of the head that radiates to the top.
  • The pain can be unilateral or bilateral (located on both sides of the head).
  • The pain may be acute or stabbing, or it may feel as though an electric pulse is being delivered through the nerve.
  • Occasionally, the pain is dull and aching or throbbing.
  • Pain sometimes radiates down the side of the head, often as far forward as the forehead.

Certain signs, such as exposure to light or sound or scalp tenderness, are often associated with migraine headaches, cluster headaches, or other types of headaches. Pain in the back of the head is a very characteristic symptom of migraine. However, this symptom is also shared by numerous other headache disorders, so it is highly unlikely to reach a diagnosis solely on the location of the headache. Unlike tension headaches, patients suffering from occipital neuralgia often define the pain more like stabbing instead of a dull throbbing.

In addition, individuals suffering from occipital Neuralgia can experience intensified pain when moving their neck. If the pain from occipital Neuralgia spreads down the side of the head and through the ears, it can initially be confused with Trigeminal Neuralgia. It has a paroxysmal shooting or stabbing nature. However, a physical examination, neurological assessment, and a review of the patient’s medical records will be done to look for abnormalities and find potential variations that will aid in making the right diagnosis.


The etiology of occipital Neuralgia is unknown. It is believed to arise as a result of stressed or inflamed occipital nerves. Numerous factors and stimuli may contribute to this debilitating neurological disorder.  including the following:

  • whiplash or other neck injuries,
  • trauma to the greater and/or lesser occipital nerves
  • tumors or other lesions affecting the C2 and C3 nerve roots
  • head injury,
  • muscle spasm or chronic muscle tightness,
  • cervical spine arthritis,
  • compression of the C2 and/or C3 nerve roots from a degenerative cervical spine condition such as osteoarthritis.
  • or other anatomical alterations in the upper cervical spine.

This form of headache characteristically occurs at the back of the head and can be caused by diabetic peripheral neuropathy, infection, or inflammation of the blood vessels.

Diagnostic tests for occipital Neuralgia

There is no clear test for diagnosing or confirming occipital Neuralgia. Physical test results include a pronounced tenderness to pressure along the occipital nerve; palpation of this area often reproduces or exacerbates the patient’s pain. It is important to make this diagnosis if the patient has tenderness over the distribution of the greater occipital nerve. In addition, there may be any related neck muscle tightness or spasm. Certain physicians will administer an occipital nerve block with a local anesthetic to see whether this will remove or alleviate the pain, thus confirming the diagnosis of the neurological disorder. Neck X-rays or CT scans may be requested where there is fear that an underlying condition (i.e a lesion or tumor affecting the nerve roots) is causing the effects. Your healthcare provider might also request MRI which uses radiofrequency energy and strong magnetic fields to create high definition images of the soft body tissues – this helps for a more detailed analysis.

Treatment of Occipital Neuralgia

Home-based Occipital Neuralgia Treatment

Apply ice/heat therapy as needed. Ice therapy can help to alleviate localized inflammation and pain. When you lay down, tuck an ice pack under the base of your skull. However, heat therapy, for example, an electrical heating pad, can provide additional relief. When you add heat to a region, the local blood vessels dilate, and blood circulation to the neck increases, which can help alleviate muscle tightness—applying the cold/heat source for more than 20 minutes at a time. Often place a layer between your skin and the cold/heat source, such as a hand towel.

Medication. Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin) and naproxen (e.g., Aleve). They can assist in reducing inflammation and relieving headache/neck pain when taken. Moreover, using muscle relaxants along with anti-inflammatory medications can also help alleviate the pain significantly. Other beneficiary medications include tricyclic antidepressants and anti-seizure drugs

Adhere to the package directions and consult a physician or pharmacist to safely take these drugs.

Self-massage your neck. Apply soft pressure to the base of the skull with your fingertips. This massage will aid in the relaxation of tense muscles and the release of tension. Additionally, you should lay on your back and put a folded towel under your head and hands. The towel’s friction will include a gentle massage. If the massage exacerbates the pain, stop immediately.

Perform chin tucks on a daily basis. Certain types of occipital Neuralgia can be due to nerve tension caused by bad posture. The chin tuck exercise stretches and strengthens the muscles and connective tissue in the sore region while still strengthening the muscles that line your head over your shoulders. With your upper back against a wall and your feet shoulder-width apart, take a position. Face forward, tuck your chin in, and draw your head back until it comes into contact with the wall. Then, attempt to straighten your head without tilting it back or nodding forward. Ten times, hold the stretch for 5 seconds before resting. If this exercise causes further pain or irritation, instantly stop.

Medicine based Occipital Neuralgia Treatment

If the pain continues, drugs can be used to calm the nerves. These drugs may include anticonvulsant or antidepressant medications. In addition, occipital nerve blocks can be achieved using an injection of a local anesthetic and a steroid agent into the affected area. These are frequently very effective at relieving debilitating pain for several weeks or even months at a time. Botulinum Toxin (Botox) injections can also be a viable option to minimize inflammation of the nerve and decrease pain in chronic headaches.

When combined with physical therapy, regular stretching and strengthening exercises, and other conservative interventions, individuals suffering from this form of headache will often function normally for several weeks or months at a time. Certain individuals discover that a single course of physical therapy or a single nerve block totally alleviates their discomfort.

If traditional treatment options are ineffective for occipital neuralgia headache pain, some more invasive therapies have been found to be effective, leading to surgical procedures.

Surgical Treatment

Stimulation of the Occipital Nerves: This surgical procedure entails placing electrodes under the skin along the occipital nerves. The treatment is identical to spinal cord stimulation and is performed using the same device. The treatment is minimally invasive, and the stimulation has no adverse effect on surrounding nerves and tissues.

Stimulation of the Spinal Cord: This surgical procedure entails the insertion of activating electrodes between the spinal cord and the vertebrae. The unit generates electrical impulses that interfere with the transmission of pain signals from the spinal cord to the brain.

Occipital release surgery: This is an invasive procedure that includes decompression of the greater occipital nerves along their course to alleviate the pain.

C2,3 Ganglionectomy- The second and third cervical sensory dorsal root ganglions are disrupted during this procedure. The study discovered that 95% of patients experienced instant relief, with 60% continuing to experience relief after one year.


Patients are advised to continue contact with their health care providers and physicians on a daily basis and ensure that their condition is improving. Surgeons prefer that patients visit the clinic every few months for the first year after surgery. They can change the relaxation settings and evaluate the patient’s recovery from surgery during these visits. Maintaining contact with a physician means that the patient is receiving appropriate and reliable treatment. Patients who undergo occipital nerve stimulation will be followed up by a device representative who will work with their physicians to change their device settings and specifications as appropriate.


  1. Choi I, Jeon SR. Neuralgias of the Head: Occipital Neuralgia. J Korean Med Sci. 2016;31(4):479-488. doi:10.3346/jkms.2016.31.4.479
  2. Occipital Neuralgia: A Guide | American Migraine Foundation. (2019, December 30). American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/occipital-neuralgia/
  3. What you need to know about occipital Neuralgia. Medicalnewstoday.com; Medical News Today. https://www.medicalnewstoday.com/articles/320143
  4. Gotter, A. (2017, May 24). Occipital Neuralgia. Healthline; Healthline Media. https://www.healthline.com/health/occipital-neuralgia

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