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Occipital Neuralgia

Muscle Tension Headaches

Occipital Neuralgia may be associated with muscle tension headaches, myofascial pain, cervical facet arthropathy and cervicalgia. Typical occipital neuralgia complaints involve posterior neck and shoulder muscular spasm and pain. The posterior scalp, the area known as the occiput, may ache constantly with intermittent sharp shooting pain. This headache may range from the occiput up to the forehead in some cases. It may be aggravated with pressure on the base of the skull or with flexion or rotation of the neck.

Commonly there is an associated scalp numbness or tingling at the back of the head. The occipital nerve is a branch of the C2 (second cervical) nerve root. Cervical spine degeneration may contribute to occipital nerve injury and may be difficult to treat. Treatment may include physical therapy, stretching, massage with muscle relaxation and stress reduction therapy. Medications such as Neurontin, analgesics and muscle relaxants may provide additional relief. Mineral supplements like Magnesium can be useful in lessening neck spasms. Nutritional supplementation coupled with a wellness product alternative may be helpful in treating this condition. Ask your doctor for a program.


The treatment of occipital neuralgia consists primarily of neural blockade with local anesthetic and steroid combined with the judicious use of nonsteroidal anti-inflammatory drugs, muscle relaxants, tricyclic antidepressants, and physical therapy. Neural blockade of the greater and lesser occipital nerves is carried out using the following technique: The patient is placed in a sitting position with the cervical spine flexed and the forehead on a padded bedside table.

The most common reason that greater and lesser occipital nerve blocks fail to relieve headache pain is that the headache syndrome being treated has been misdiagnosed as occipital neuralgia. Any patient with headaches that are so severe as to require neural blockade as part of the treatment plan should undergo magnetic resonance imaging of the head to rule out unsuspected intracranial pathology. Furthermore, cervical spine radiographs should be considered to rule out congenital abnormalities such as Arnold-Chiari malformations that may be the hidden cause of the patient’s occipital headaches.

Injectable therapy includes direct occipital nerve block with local anesthetic and steroid. Treatment of cervical (neck) muscular spasm with Trigger point injections or cervical facet blocks may also ameliorate the condition. These procedures are well tolerated. Confirmation of correct placement of the needle with medication occurs when pain is reproduced during injection. Complications are extremely rare. You may wish to discuss these with your pain doctor. Many patients will require a series of injections to control pain.

Occipital nerve block. Via a needle inserted at the base of the skull, an anesthetic agent is injected around the origin of the greater occipital nerve.




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