Occipital Neuralgia

• Headaches are often best investigated by a Neurologist, who will determine if a spinal consultation is appropriate. They are best placed to identify the type of headache and rule out more serious diagnoses.
• Headache originating from the upper cervical (neck) joints can be termed Cervicogenic Headache. When this happens, the headache usually starts in the neck or back of the head and spreads to the front of the head or temples. The headache is typically one-sided, and the pain worsens with neck movements. In some cases, people will have reduced neck movement or pain when touching the neck. Usually, this occurs later in life (after about age 50) as cervical spondylosis develops, but it can happen earlier if there is a history of neck pain or injury.

Most of the sensation of the scalp in the back and top of the head is transmitted via the two greater occipital nerves. One left and one right.

Exiting the spine between the upper cervical vertebrae, these nerves pass through muscles at the back of the head and into the scalp.

They can reach as far forward as the forehead but do not cover the face.

Irritation of these nerves can produce pain in this distribution.

The pain's character is variable but can be described as tingling or electrical. Some patients develop severe scalp sensitivity/tenderness. Often, tenderness is present at the base of the skull at the soft tissue insertion of the neck muscles.

Occipital neuralgia may occur without identifiable cause or as a result of nerve compression in the neck secondary to cervical spondylosis. Previous surgery or injury is sometimes implicated. Simply chronic muscle spasms at the back of the head can irritate the nerve sufficiently to cause these symptoms.

Certain diagnoses are, at times, challenging. History, examination and response to occipital nerve blocks generally form the basis of investigation. Speak to your Neurologist.

One reason the diagnosis is challenging is that true isolated occipital neuralgia is actually quite rare. Other types of headaches can mimic occipital neuralgia, including migraine. These patients are generally diagnosed as having migraines involving the greater occipital nerve rather than as having occipital neuralgia itself.