What occipital neuralgia is
Occipital neuralgia is a headache disorder characterised by recurrent short-lasting or continuous electric-shock-like pain in the distribution of the greater or lesser occipital nerve — from the occiput to the vertex or lateral scalp. The pain may be triggered by neck movement, sustained postures, or pressure over the occipital region.
Secondary causes include cervical spine pathology, disc herniation, atlantoaxial joint abnormalities, tumours or inflammation. Idiopathic occipital neuralgia is diagnosed when secondary causes are excluded. Careful history distinguishes occipital neuralgia from migraine, tension-type headache and cervicogenic headache, which may overlap.
- Electric-shock-like pain from occiput to vertex or lateral scalp
- Triggered by neck movement, sustained postures, or occipital pressure
- Secondary causes: cervical pathology, disc herniation, tumours
- Idiopathic when secondary causes are excluded
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Nerve blocks, medication and physical therapy
Greater occipital nerve block is both diagnostic and therapeutic — if the block relieves pain, the occipital nerve is confirmed as the pain source. Repetitive blocks may be needed for sustained relief. Peripheral nerve stimulation is considered for refractory cases.
Medication management includes gabapentin, pregabalin, amitriptyline or carbamazepine depending on pain character and comorbidities. Physical therapy addresses cervical posture, muscle tension and trigger points contributing to nerve irritation. Evaluation excludes cervical spine pathology requiring surgical intervention.
- Greater occipital nerve block — diagnostic and therapeutic
- Medication: gabapentin, pregabalin, amitriptyline, carbamazepine
- Physical therapy for cervical posture and trigger points
- Peripheral nerve stimulation for refractory cases