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Occipital Neuralgia

A common cause of headache, occipital neuralgia involves the occipital nerves, two pairs of nerves that originate in the area of the second and third vertebrae of the neck (C2 and C3). Pain typically starts at the base of the skull by the nape of the neck and may radiate to the back, front and side of the head, as well as behind the eyes.

Chronically contracted neck muscles or neck tension can cause occipital neuralgia. Other causes include an underlying disease or injury, including tumor, trauma, infection, systemic disease or hemorrhage. In some cases, the cause is unknown.

Common causes include:

  • Osteoarthritis of the upper cervical spine
  • Trauma to the greater and/or lesser occipital nerves
  • Compression of the greater and/or lesser occipital nerves or the C2 and/or C3 nerve roots resulting from degenerative cervical spine changes
  • Cervical disc disease
  • Tumors affecting the C2 and C3 nerve roots
  • Gout
  • Diabetes
  • Blood vessel inflammation
  • Infection

Common Symptoms

  • Continuous aching, burning and throbbing pain with occasional shocking or shooting pain
  • Symptoms similar to migraines and cluster headaches
  • Pain originating at the base of the skull and radiating to the back or side of the scalp
  • Pain behind the eye on the affected side
  • Tenderness of the scalp to touch


Diagnosis is difficult because occipital neuralgia has symptoms similar to other types of headaches. Your pain medicine specialist will do a thorough evaluation, including a medical history and physical examination. If there are abnormal findings on a neurological exam, your doctor may order an MRI or a CT scan.


Our treatment goal is to alleviate the pain. Often, symptoms will improve or disappear with heat, rest, physical therapy, massage, anti-inflammatory medications and muscle relaxants. Oral anticonvulsant medications such as carbamazepine and gabapentin may also help reduce pain.

Percutaneous nerve blocks may be helpful in diagnosing occipital neuralgia and may also help reduce pain. Nerve blocks involve either the occipital nerves or in some patients, the C2 and/or C3 ganglion nerves.

Occipital nerve stimulation uses an implantable neurostimulator that delivers electrical impulses through insulated lead wires tunneled under the skin near the occipital nerves at the base of the head. The electrical impulses can help block pain messages to the brain. The procedure is minimally invasive, and the nerves and other surrounding structures are not permanently damaged.

Surgical procedures include microvascular decompression. A neurosurgeon will expose the affected nerves using microsurgical techniques, identify and blood vessels that might be compressing the nerves and gently move them away from the point of compression. Decompression may reduce sensitivity and allow the nerves to recover and return to a more normal, pain-free condition.

Source: American Association of Neurological Surgeons

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