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{{Infobox medical condition (new)
{{Short description|Chronic pain disorder affecting the occipital nerves}}
{{Infobox medical condition
| name            = Occipital neuralgia
| name            = Occipital neuralgia
| synonyms        = C2 neuralgia, Arnold's neuralgia
| synonyms        = C2 neuralgia, Arnold's neuralgia
| image          =
| field          = [[Neurology]]
| caption        =
| symptoms        = Chronic headache, neck pain, pain behind the eye, light sensitivity
| pronounce      =
| complications  = Misdiagnosis, disability, chronic pain
| field          = neurology
| onset          = Variable
| symptoms        =  
| duration        = Chronic
| complications  =  
| types          = Greater and lesser occipital neuralgia
| onset          =  
| causes          = Nerve compression or irritation
| duration        =  
| risks          = Neck trauma, repetitive neck movement, cervical disc disease
| types          =  
| diagnosis      = Clinical evaluation, nerve blocks, imaging
| causes          =  
| differential    = [[Migraine]], [[Tension headache]], [[Cluster headache]], [[Cervicogenic headache]]
| risks          =  
| prevention      = Avoiding neck strain and repetitive stress
| diagnosis      =  
| treatment      = Physical therapy, nerve blocks, medications, surgery (in rare cases)
| differential    =  
| medication      = NSAIDs, muscle relaxants, antidepressants, anticonvulsants
| prevention      =  
| prognosis      = Often manageable with appropriate treatment
| treatment      =  
| frequency      = Rare
| medication      =  
| deaths          = Rare, not typically fatal
| prognosis      =  
| frequency      =  
| deaths          =  
}}
}}
'''Occipital neuralgia''' is a medical condition characterized by [[chronic pain]] in the upper [[neck]], back of the [[head]] and behind the [[human eye|eye]]s. These areas correspond to the locations of the [[lesser occipital nerve|lesser]] and [[greater occipital nerve]]s. Wrapped around the greater occipital nerve is the [[occipital artery]], which can contribute to the neuralgia. The condition is also sometimes characterized by diminished sensation in the affected area.
[[File:Gray800.png|Occipital nerver (Gray's anatomy)|thumb]]
'''Occipital neuralgia''' is a chronic pain disorder characterized by inflammation or irritation of the [[greater occipital nerve]], [[lesser occipital nerve]], or both. These nerves originate in the cervical spine and provide sensation to the back of the [[head]] and upper [[neck]], and irritation may result in sharp or throbbing pain in these areas. The condition may be unilateral or bilateral and is sometimes referred to as '''C2 neuralgia''' or '''Arnold's neuralgia'''.


==Signs and symptoms==
== Signs and symptoms ==
The main [[symptom]] of occipital neuralgia is chronic [[head pain|headache]]. The pain is commonly localized in the back and around or over the top of the head, sometimes up to the eyebrow or behind the eye. Because chronic headaches are a common symptom of numerous conditions, occipital neuralgia is often misdiagnosed at first, most commonly as [[tension headache]]s or migraines, leading to unsuccessful treatment attempts. Another symptom is sensitivity to light, especially when headaches occur.{{citation needed|date=July 2016}}
Occipital neuralgia presents with a distinct set of symptoms, typically involving:


Occipital neuralgia is characterized by severe pain that begins in the upper neck and back of the head. This pain is typically one-sided, although it can be on both sides if both occipital nerves have been affected. Additionally, the pain may radiate forward toward the eye as it follows the path of the occipital nerve(s). Individuals may notice [[blurred vision]] as the pain radiates near or behind the eye. The pain is commonly described as sharp, shooting, zapping, an electric shock, or stabbing. The bouts of pain are rarely consistent, but can occur frequently depending on the damage to the nerves. The amount of time the pain lasts typically varies each time the symptom appears; it may last a few seconds or be almost continuous. Occipital neuralgia can last for hours or for several days.
* Chronic [[headache]] starting in the upper neck and radiating over the scalp
* Sharp, stabbing, or shooting pain described as electric shock-like
* Pain behind one or both [[eyes]]
* Tenderness of the scalp
* Sensitivity to touch, sound, and [[light]]
* [[Nausea]] or [[vomiting]]
* Neck stiffness or pain worsened by movement
* Episodes of blurred [[vision]] during pain flare-ups


Other symptoms of occipital neuralgia may include: {{citation needed|date=April 2018}}
The pain may last for seconds, minutes, or persist for hours to days. Because symptoms can mimic [[migraine]]s or [[tension headache]]s, misdiagnosis is common.


*Aching, burning, and throbbing pain that typically starts at the base of the head and radiates to the scalp
== Causes ==
*Pain on one or both sides of the head
Occipital neuralgia arises from irritation or compression of the occipital nerves. Known causes and contributing factors include:
*Pain behind the eye
*Sensitivity to light
*Sensitivity to sound
*Pain when moving the neck
*Tender scalp
*[[Nausea]] and/or [[vomiting]]


==Causes==
* Repetitive neck movements (flexion, extension)
Occipital neuralgia is caused by damage to the occipital nerves, which can arise from [[Physical trauma|trauma]] (usually [[Concussion|concussive or cervical ]]), physical stress on the nerve, repetitive neck contraction, flexion or extension, and/or as a result of medical complications (such as [[osteochondroma]], a benign bone tumour). A rare cause is a [[cerebrospinal fluid leak]].<ref>{{cite journal|last=Ansari|first=H.|author2=Garza, I.|title=Occipital Neuralgia Secondary to a Spontaneous CSF Leak (P03.218)|journal=Neurology|date=22 April 2012|volume=78|issue=Meeting Abstracts 1|pages=P03.218|doi=10.1212/WNL.78.1_MeetingAbstracts.P03.218}}</ref> Another is [[Radiofrequency ablation|radio frequency nerve ablation]].<ref>{{cite journal|last1=Gazelka|first1=Halena M|last2=Knievel|first2=Sarah|last3=Mauck|first3=W. David|last4=Moeschler|first4=Susan|last5=Pingree|first5=Matthew|last6=Rho|first6=Richard|last7=Lamer|first7=Tim|title=Incidence of neuropathic pain after radiofrequency denervation of the third occipital nerve|journal=Journal of Pain Research|volume=7|date=April 2014|pages=195–8|doi=10.2147/JPR.S60925|pmid=24748815|pmc=3986282}}</ref> Rarely, occipital neuralgia may be a symptom of [[metastasis]] of certain [[cancer]]s to the spine.<ref>{{cite journal|last=Moulding|first=HD|author2=Bilsky, MH|title=Metastases to the craniovertebral junction.|journal=Neurosurgery|date=March 2010|volume=66|issue=3 Suppl|pages=113–8|pmid=20173512|doi=10.1227/01.NEU.0000365829.97078.B2}}</ref>  Among other cranial neuropathies, occipital neuralgia is also known to occur in patients with [[multiple sclerosis]].<ref>{{cite journal|last=De Santi|first=L|last2=Annunziata|first2=P|title=Clin Neurol Neurosurg|journal=Clinical Neurology and Neurosurgery|date=February 2012 |volume=114|issue=2|pages=101–7|doi=10.1016/j.clineuro.2011.10.044|pmid=22130044}}</ref>  Hodgkins and other cancer survivors who have had radiation treatment to the neck also can develop this, sometimes many years later.
* [[Whiplash]] or other [[neck trauma]]
* Degenerative cervical spine conditions
* [[Osteoarthritis]]
* Cervical [[herniated disc]]
* [[Osteochondroma]] (benign bony growths)
* [[Diabetes mellitus]] (due to peripheral neuropathy)
* Post-surgical complications
* Compression by the [[occipital artery]]


There are several areas that have the potential to cause injury from compression:
In many cases, the cause is idiopathic (unknown).


#The space between the [[Atlas (anatomy)|C1]] and [[Axis (anatomy)|C2]] [[vertebra]]e
== Diagnosis ==
#The atlantoaxial ligament as the [[dorsal ramus]] emerges
Diagnosis is primarily clinical, based on symptom patterns and exclusion of other headache types. Techniques include:
#The deep to superficial turn around the inferiolateral border of the [[obliquus capitis inferior muscle]] and its tight investing [[fascia]]
#The deep side of [[semispinalis capitis]], where initial piercing can involve entrapment in either the muscle itself or surrounding fascia
#The superficial side of semispinalis capitis, where completion of nerve piercing muscle and its fascia again poses risk
#The deep side of the [[trapezius]] as the nerve enters the muscle
#The [[tendon|tendinous]] insertion of the trapezius at the superior [[nuchal line]]
#The neurovascular intertwining of the greater occipital nerve and the occipital artery


==Diagnosis==
* Physical examination and patient history
The diagnosis is established clinically through characteristic symptoms (mostly short attacks of an intense sharp, piercing or electrifying pain with propagation along the occipital nerve from the lateral neck and under/behind the ear towards the side of the head and the eye, with often longer lasting background pain) and sometimes supporting clinical features.
* Palpation of the occipital nerve region to elicit tenderness or pain
* Diagnostic [[nerve block]] – injection of local anesthetic near the occipital nerves, with pain relief supporting the diagnosis
* [[MRI]] or [[CT scan]] – to rule out structural causes such as tumors or disc herniation


==Treatment==
== Differential diagnosis ==
There are a wide range of non-invasive treatments, including manipulation, [[physical therapy]], rest, heat, [[Anti-inflammatory|anti-inflammatory medication]], [[antidepressant]]s, [[Anticonvulsant|anti-convulsants]], opioid and non-opioid [[analgesic]]s, ketamine infusion therapy, and [[migraine]] prophylaxis medication. Alternatives include local [[nerve block]], peripheral nerve stimulation, [[steroids]], [[rhizotomy]], [[phenol]] injections, and [[Occipital Cryoneurolysis|occipital cryoneurolysis]].
Occipital neuralgia is often confused with:
Less commonly, surgical [[neurolysis]] or [[Spinal decompression|microdecompression]] are used to treat the condition when conservative measures fail.{{citation needed|date=February 2016}}


==References==
* [[Migraine]]
{{reflist}}
* [[Tension-type headache]]
Frei R. Large study: Frequent nausea worsens migraine severity. Pain Med News 2011;9(8):1– 20.
* [[Cluster headache]]
* [[Trigeminal neuralgia]]
* [[Cervicogenic headache]]


Liang, H. Occipital Neuralgia as a presenting symptom of gastric cancer metastasis. ''Imaging in Headache Medicine, April 2012.''
A thorough neurological evaluation is essential to differentiate these conditions.
Saladin, Kenneth S. "Chapter 13: The Spinal Cord, Spinal Nerves, and Somatic Reflexes." Anatomy & Physiology: The Unity of Form and Function. 12th ed. New York, NY: McGraw-Hill, 2012. N. pag. Print.


Stedman, Thomas Lathrop. Stedman's Medical Dictionary—27th Edition Illustrated in Color. 27th ed. Philadelphia: Lippincott Williams & Wilkins, 2000. 1206+. Print.
== Treatment ==
Treatment aims to reduce pain and inflammation and may include:


Williamson et al. The Journal of Headache and Pain 2013, 1(Suppl 1):P65 http://www.thejournalofheadacheandpain.com/content/1/S1/P65
=== Conservative management ===
* [[Rest]] and neck support
* [[Physical therapy]] and [[massage therapy]]
* [[Heat therapy]] or [[cold compresses]]


http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/headache/conditions/occipital_neuralgia.html
=== Medications ===
* [[Nonsteroidal anti-inflammatory drugs]] (NSAIDs)
* [[Muscle relaxants]]
* [[Antidepressants]] (e.g., [[amitriptyline]])
* [[Anticonvulsants]] (e.g., [[gabapentin]], [[pregabalin]])


== External links ==
=== Interventional procedures ===
{{Medical resources
* [[Occipital nerve block]] – local anesthetic and steroid injection
|  DiseasesDB    =  
* [[Botulinum toxin]] injections
|  ICD10          = {{ICD10|G|52|8|g|50}}, G44.847
* [[Pulsed radiofrequency therapy]]
|  ICD9          = {{ICD9|723.8}}
 
|  ICDO          =  
=== Surgery ===
|  OMIM          =  
In cases unresponsive to conservative therapies:
|  MedlinePlus    =  
* [[Occipital nerve stimulation]]
|  eMedicineSubj  =
* [[Microvascular decompression]]
|  eMedicineTopic =
* [[Rhizotomy]]
|  MeshID        =
 
}}
== Prognosis ==
*https://www.ninds.nih.gov/Disorders/All-Disorders/Occipital-Neuralgia-Information-Page
With early diagnosis and proper management, occipital neuralgia can often be controlled. Some patients may experience recurrent or chronic symptoms, but interventions typically offer significant relief.
 
== See also ==
* [[Headache]]
* [[Neuropathic pain]]
* [[Trigeminal neuralgia]]
* [[Cervicogenic headache]]
* [[Peripheral nerve disorders]]
[[Category:Neurological disorders]]
[[Category:Headaches]]
[[Category:Pain disorders]]
[[Category:Rare diseases]]
{{nt}}
{{Headache}}
{{Headache}}
[[Category:Neurological disorders]]
[[Category:Neurological disorders]]
{{dictionary-stub1}}
<gallery>
File:Gray800.png
File:CC-BY_icon.svg
</gallery>

Latest revision as of 03:25, 30 March 2025

Chronic pain disorder affecting the occipital nerves


Occipital neuralgia
Synonyms C2 neuralgia, Arnold's neuralgia
Pronounce N/A
Specialty N/A
Symptoms Chronic headache, neck pain, pain behind the eye, light sensitivity
Complications Misdiagnosis, disability, chronic pain
Onset Variable
Duration Chronic
Types Greater and lesser occipital neuralgia
Causes Nerve compression or irritation
Risks Neck trauma, repetitive neck movement, cervical disc disease
Diagnosis Clinical evaluation, nerve blocks, imaging
Differential diagnosis Migraine, Tension headache, Cluster headache, Cervicogenic headache
Prevention Avoiding neck strain and repetitive stress
Treatment Physical therapy, nerve blocks, medications, surgery (in rare cases)
Medication NSAIDs, muscle relaxants, antidepressants, anticonvulsants
Prognosis Often manageable with appropriate treatment
Frequency Rare
Deaths Rare, not typically fatal


Occipital nerver (Gray's anatomy)

Occipital neuralgia is a chronic pain disorder characterized by inflammation or irritation of the greater occipital nerve, lesser occipital nerve, or both. These nerves originate in the cervical spine and provide sensation to the back of the head and upper neck, and irritation may result in sharp or throbbing pain in these areas. The condition may be unilateral or bilateral and is sometimes referred to as C2 neuralgia or Arnold's neuralgia.

Signs and symptoms[edit]

Occipital neuralgia presents with a distinct set of symptoms, typically involving:

  • Chronic headache starting in the upper neck and radiating over the scalp
  • Sharp, stabbing, or shooting pain described as electric shock-like
  • Pain behind one or both eyes
  • Tenderness of the scalp
  • Sensitivity to touch, sound, and light
  • Nausea or vomiting
  • Neck stiffness or pain worsened by movement
  • Episodes of blurred vision during pain flare-ups

The pain may last for seconds, minutes, or persist for hours to days. Because symptoms can mimic migraines or tension headaches, misdiagnosis is common.

Causes[edit]

Occipital neuralgia arises from irritation or compression of the occipital nerves. Known causes and contributing factors include:

In many cases, the cause is idiopathic (unknown).

Diagnosis[edit]

Diagnosis is primarily clinical, based on symptom patterns and exclusion of other headache types. Techniques include:

  • Physical examination and patient history
  • Palpation of the occipital nerve region to elicit tenderness or pain
  • Diagnostic nerve block – injection of local anesthetic near the occipital nerves, with pain relief supporting the diagnosis
  • MRI or CT scan – to rule out structural causes such as tumors or disc herniation

Differential diagnosis[edit]

Occipital neuralgia is often confused with:

A thorough neurological evaluation is essential to differentiate these conditions.

Treatment[edit]

Treatment aims to reduce pain and inflammation and may include:

Conservative management[edit]

Medications[edit]

Interventional procedures[edit]

Surgery[edit]

In cases unresponsive to conservative therapies:

Prognosis[edit]

With early diagnosis and proper management, occipital neuralgia can often be controlled. Some patients may experience recurrent or chronic symptoms, but interventions typically offer significant relief.

See also[edit]


Headache
Primary
Secondary
ICHD 13
Other
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