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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.

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. Botulinum Toxin (Botox) injections can also be a viable option to minimize inflammation of the nerve and decrease pain in chronic headaches. Unfortunately, these treatments are not a long-term solution. A more long term solution is Prolozone Therapy.

Prolozone Therapy

Many of the structures around the occipital nerve have a poor blood supply, which is why they struggle to heal and remain irritated around the never. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolozone Therapy involves the injection of oxygen and nutrients into these structures to provide a direct supply of what is needed to heal them and reduce the irritation around the occipital nerve.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix. For more information about this treatment and video testimonials please click on the image below:

Collection of reviews

When combined with physical therapy, regular stretching and strengthening exercises, and other conservative interventions, individuals suffering from this form of headache will go back to functioning normally.

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.

Frequently Asked Questions:

What triggers occipital neuralgia?

Many conditions can trigger occipital neuralgia, but strained nerves mainly bring about occipital neuralgia in the origin of an individual’s neck. In some cases, this is brought about by too taut muscles in an individual’s channel. At times, it very well may be brought about by an injury of the head or neck. Chronic neck strain is another common reason. Moreover, it may occur spontaneously.

How do you make occipital neuralgia go away?

You can make your occipital neuralgia go away by following this strategy:

  • Applying heat and resting in a quiet room can help get a soothing effect.
  • Massaging tight muscles of the neck can relieve pain.
  • Anti-inflammatory medication may be used.
  • More consideration regarding diet, precisely, vitamin B might assist with alleviating occipital neuralgia by helping the body’s capacity to mend itself.
  • Some patients may require surgical treatment.

Can occipital neuralgia go away on its own?

Yes, occipital neuralgia may go away on its own, but it may take some time. Not every individual requires medication and surgery. One can get rid of occipital neuralgia on its own if the cause of inflammation is corrected.

Is occipital neuralgia serious?

Occipital neuralgia is not a life-threatening situation. The pain can be easily relieved by taking proper rest and using anti-inflammatory medications. However, in some cases, the aggravation can be significantly weakening for patients. Many of them find it challenging to go on with their ‘typical’ lives because the aggravation is unbearable, and they find it hard to focus.

Does occipital neuralgia show up on MRI?

Radiographic imaging is of restricted utility in determining occipital neuralgia however is fundamentally concerned about barring underlying pathology of the spinal cord, the spine, the occipital nerves, or contiguous designs. Accordingly, MRI (Magnetic resonance imaging) is the most ideal for this assignment. Cervical string MRI should be considered for headstrong occipital neuralgia, particularly for those cases that can’t be settled by blocking the occipital nerve.

Does stress cause occipital neuralgia?

Persistent stress is a constant issue that can prompt tight shoulders and neck, so that chronic stress might be the reason for occipital neuralgia.


  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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