Introduction
Neuralgia is the medical term used to describe an intense, sometimes stabbing or burning pain along the length of a nerve.
The three occipital nerves ('occipital' meaning 'back of the head') are called the greater, lesser and third occipital nerves, and they provide sensory information to the brain from the top and back of the head as well as from behind the ears. These nerves start at the upper cervical (neck) nerves and come up behind the base of the skull following the neck muscles to the scalp.
The pain of occipital neuralgia affects the neck and the back of the head and can also spread to the temples and the top of the skull, even to behind the eyes.
Occipital neuralgia is classified as a chronic headache disorder, albeit relatively rare – it affects a little less than one in 30,000 people.
Causes
The primary cause of the condition is some form of damage to either the greater or the lesser occipital nerve. This can be caused by the following…
- Head or neck trauma.
- Head or neck surgery.
- Thicker than normal ligaments in the neck (which can trap the C2 nerve root in the upper neck).
- Chronic tension in the neck.
- Osteoarthritis of the cervical section of the spine.
- Degenerative disc disease affecting the cervical (neck) section of the spine.
- Tumour compressing either the C2 or C3 nerve root.
- Infection.
- Medical conditions which affect the nervous system e.g. diabetes, gout.
- Blood vessel inflammation.
Symptoms
The major symptom of occipital neuralgia is a chronic headache with sharp, stabbing pain which starts in the upper neck and back of the head and can then radiate up towards the temples, the top of the head and in some cases behind the eye (which can sometimes cause blurred vision).
Less commonly, some people may experience the following symptoms…
- Nausea / vomiting.
- Problems maintaining balance and / or coordination.
- Difficulty speaking.
- Heightened sensitivity to light and sounds and touch.
Occipital neuralgia generally only affects one side of the head. Bouts can last anything from a few seconds to days.
Tests / Diagnosis
If you respond to local anaesthetic injections around these nerves, this would tend to support the diagnosis and be the basis for further treatment.
The first step in diagnosing the condition is a review of medical history and symptoms. It can be difficult to diagnose occipital neuralgia and it shares a number of symptoms with other conditions, like migraine for example.
In some instances, the doctor will palpate (i.e. touch) the greater and / or lesser occipital nerve to see if this results in a sharp pain along the nerve (this test is referred to as a 'Positive Hoffman's sign').
Further tests which may be recommended, in part to rule out other possible causes, include a CT scan or MRI scan. In some instances, the doctor may recommend an occipital nerve block (i.e. anaesthetic) which, if the pain diminishes or goes away, may confirm the condition.