If you’re experiencing chronic pain behind your head or eyes, or you have sensitivity to light, you may be wondering if you have occipital neuralgia. Some treatments can be more conservative, while others are more interventional. With the correct information and diagnosis, you can start a treatment plan that works for you.
What Is Occipital Neuralgia?
Occipital neuralgia is a headache disorder that can cause sharp, shooting pain on the scalp or behind the eyes. The occipital nerves are found in the skull and send messages from the skull to the brain. They play an essential role in brain health and function.
With occipital neuralgia, the occipital nerves become inflamed, irritated or swollen.
What Causes Occipital Neuralgia?
Occipital neuralgia can have various causes, including primary and secondary causes. Some lifestyle factors may also play a role in the cause and progression of the disorder:
- Primary causes: These can include a pinched nerve root in the neck, nerve compression, injury or inflammation.
- Secondary causes: Some secondary causes are underlying medical conditions, such as diabetes, arthritis, multiple sclerosis or viral infections.
- Contributing lifestyle factors: Poor posture, lack of exercise, choice of sleep position or constant strain may lead to occipital neuralgia.
Common Symptoms
Some common symptoms of occipital neuralgia include:
- Sensitivity to light or pain behind the eyes
- Sharp pain behind the back of the head or neck
- Scalp tenderness
- Difficulty moving the neck
Diagnosis
Because occipital neuralgia also includes symptoms of headaches and migraine, it can be challenging to diagnose. There’s no single diagnosis, and your doctor may order several tests, including:
- Patient history and physical exam: Your doctor will ask about your health history and conduct several physical exams.
- Imaging tests: An MRI or CT scan can be helpful for diagnosing occipital neuralgia.
- Diagnostic nerve blocks: Some patients may receive diagnostic nerve blocks, an injection containing local anesthetic to specific nerves to temporarily relieve pain.
Treatment Options and When to Seek Professional Help
There are several treatment options for occipital neuralgia, and some are more targeted than others, depending on your doctor’s recommendation. It’s crucial to seek help if you have sharp pain behind your neck and are experiencing double or loss of vision, fever or slurred speech.
Noninvasive Treatments
Some noninvasive options to relieve occipital neuralgia pain include:
- Heat therapy and relaxation, such as heat pads, stretching and yoga.
- Physical therapy, including applying gentle pressure or massage from a licensed physical therapist.
- Medications including muscle relaxers, anti-inflammatory drugs or other medications your doctor prescribes.
Minimally Invasive Procedures
Depending on the symptoms, your doctor may suggest one or more of the following:
- Radiofrequency ablation (RFA): The occipital nerves are heated using radiofrequency energy, which helps prevent the nerves from sending pain signals to the brain.
- Nerve blocks and steroid injections: Your doctor may provide anesthetic injections, which could also include steroids to help relieve inflammation and pain.
Surgical Options for Severe Cases
In the case of severe occipital neuralgia, a doctor may prescribe surgery if other methods fail.
One surgical option is occipital release surgery, an outpatient procedure lasting about three hours. During the procedure, an incision is made at the back of the neck. The occipital nerves are then decompressed to release them from the surrounding tissue.
This surgery is appropriate only for the most severe cases. Results can vary, and permanent relief from pain is not always guaranteed. Following surgery, patients must return within a year for another surgical procedure.
