Definition and Overview
Occipital neuralgia is a distinctive headache disorder characterized by paroxysmal sharp, shooting, or electric shock-like pain in the distribution of the greater, lesser, or third occipital nerves [1].
Pain typically originates at the suboccipital region and radiates to the vertex, temporal area, or behind the eye. Between paroxysms, a dull aching sensation often persists in the occipital region.
Causes
Nerve entrapment by cervical muscles (semispinalis capitis, trapezius) is the most common cause. Other causes include cervical spine pathology (C2-C3 arthropathy, disc herniation), trauma (whiplash), posterior fossa tumors, and post-surgical nerve injury [2].
Symptoms
- Sharp, stabbing, or electric shock-like pain in the occipital region
- Pain radiating from the base of skull to the vertex
- Tenderness over the greater occipital nerve (midpoint between mastoid and occipital protuberance)
- Dysesthesia or numbness in the affected area
- Pain aggravated by neck movement
Diagnosis
Clinical diagnosis based on characteristic pain pattern and tenderness over the occipital nerve. Diagnostic occipital nerve block (local anesthetic at the occipital nerve) providing temporary relief confirms the diagnosis [3].
Cervical spine MRI may be needed to exclude structural causes. NCS can assess nerve function.
Treatment
Physical therapy: cervical stretching, posture correction, and soft tissue mobilization. Occipital nerve blocks (local anesthetic + corticosteroid) provide relief lasting weeks to months [4].
Botulinum toxin injection around the greater occipital nerve shows efficacy in refractory cases. Medications: gabapentin, pregabalin, carbamazepine, or muscle relaxants. Radiofrequency ablation and occipital nerve stimulation are options for chronic refractory cases [5].