Occipital neuralgia is a health condition that causes chronic pain in the upper neck, back of the head, and behind the eyes. These areas correspond to the locations of the minor and major occipital nerves in the head. Around the major occipital nerve is the occipital artery, which can cause neuralgia. This condition is sometimes characterized by decreased sensation in the affected area.
Signs and symptoms Occipital Neuralgia
Occipital neuralgia has chronic headache as its main symptom. This pain is usually located in the back and around or over the top of the head, sometimes up to the eyebrow or behind the eye. Since headache is chronic and a common symptom of many ailments, occipital neuralgia is often misdiagnosed early in the disease, mostly as tension headaches or migraines, leading to the failure of treatment attempts.
Another symptom is sensitivity to light, especially when headaches occur as a result.
Occipital neuralgia is defined as an intense pain that manifests itself in the upper neck and the back of the head. Usually this pain is on one side only, but can be on both sides if both occipital nerves have been affected. On the other hand, the pain may spread to the eye following the path of the occipital nerve. The patient may notice blurred vision when the pain spreads near or behind the eye. This pain is commonly described as sharp, stabbing, tapping, electric shock, or shooting pain. Pain attacks are rarely consistent, although they may occur frequently depending on the nerve damage. The length of time the pain lasts usually varies each time the symptom occurs; they may last a few seconds or be almost continuous. Occipital neuralgia can last for hours or several days.
Other symptoms of occipital neuralgia may include
- Painful, burning, stabbing, usually starts at the base of the head and radiates to the scalp.
- Headache on one or both sides
- pain in the back of the eye
- Sensitivity to light
- Sensitivity to sound
- Wrong language...
- There's pain when you move your neck.
- Difficulty in maintaining balance and coordination.
- Delicate scalp
- Nausea and/or vomiting
Causes of Occipital Neuralgia
Occipital neuralgia is due to damage to the occipital nerves, which can occur from trauma (usually a concussion or neck injury), from physical stress on the nerve, from repeated contraction, flexion, or extension of the neck, and/or from medical complications (such as osteochondroma, a benign bone tumor). Another rare cause is cerebrospinal fluid leakage and radiofrequency ablation of the nerve. Rarely, occipital neuralgia may be a symptom of metastasis from certain types of spinal cancer. In addition to other cranial neuropathies, occipital neuralgia is also known to occur in patients with multiple sclerosis. Hodgkins and other cancer survivors who have received radiation therapy to the neck may also have occipital neuralgia, sometimes even many years later.
There are several areas that have the potential to cause compression injury:
- The spaces between the C1 and C2 vertebrae
- The atlantoaxial ligament emerges as the dorsal branch
- The turn from deep to superficial around the infiltrated edge of the inferior oblique muscle of the capitis and its narrow inversion fascia
- The deep part of the semispinal capitis, where the initial perforation may involve entrapment in the surrounding muscle or fascia.
- The superficial part of semispinal capitis, where the termination of the muscle through the nerves and its fascia again poses a risk
- The deepest side of the trapezium, like the nerve, enters the muscle...
- The penetration of the trapezium into the upper line of the neck...
- The neurovascular network of the major occipital nerve and occipital artery
Diagnosis of Occipital Neuralgia
This diagnosis is clinically determined by characteristic anamnestic information (mostly short bursts of sharp, deep or electrifying pain extending along the occipital nerve from the side of the neck and below/behind the ear to the side of the head and eye, usually a more lasting background pain) and sometimes by clinical features of support (Hoffmann positive sign, dysesthesia).
Occipital Neuralgia Treatment
A wide range of non-invasive treatments are available, including manipulation, physiotherapy, rest, heat, anti-inflammatory drugs, antidepressants, anticonvulsants, opioids and non-opioid analgesics, ketamine infusion therapy and the administration of drugs for migraine prophylaxis,occipital neuralgia injection. Options include local nerve blocks, peripheral nerve stimulation, steroids, rhizotomy, phenol injections, and occipital cryoneurolysis. Less commonly, surgical neurolysis or micro-decompression is used in the treatment of the condition when conservative measures fail.
Non-surgical treatment
The purpose of Neuralgia treatment occipital is to relieve pain. Often, symptoms improve or disappear with heat, rest, and some physical therapy, including massage, anti-inflammatory medications, and muscle relaxants. Oral anti-convulsants such as carbamazepine and gabapentin may also help relieve the patient's pain through therapy.
Percutaneous nerve blocks are not only useful in diagnosing occipital neuralgia, but can help to relieve the patient's pain. Nerve blocks involve the occipital nerves or, in some patients, the C2 and/or C3 ganglion nerves. It should be noted that the use of steroids in the treatment of nerve blocks can produce very serious adverse effects.
Surgery
Surgery may be considered when the pain is chronic and severe and does not respond to conservative treatment. The advantages of surgery should always be carefully considered in relation to its risks.
The microvascular decompression procedure involves the application of microsurgery to the affected nerves, the location of blood vessels that may be pressing on the nerves, and the gentle movement of the nerves away from the point of compression. Decompression is a procedure that can reduce sensation and cause the nerves to recover and return to their normal state without pain. Treatment of the nerves may include the C2 nerve root, ganglion, and postganglionic nerve.
Occipital nerve stimulation uses a neurostimulator to send electrical impulses through insulated conducting wires, tunneled under the skin near the occipital nerves at the base of the head. These electrical impulses help block pain messages from reaching the brain. The advantage of this procedure is that it is a minimally aggressive procedure and that the nerves and other structures around it are not permanently damaged.
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