Common Conditions
Greater Occipital Neuralgia
Greater occipital neuralgia is a type of headache caused by irritation or compression of the greater occipital nerves, which run from the upper neck to the scalp. This condition can lead to sharp, stabbing, or throbbing pain that starts at the base of the skull and radiates upward to the back or side of the head, sometimes reaching behind the eyes. The pain is often one-sided but can affect both sides in some cases. It has features of a mild migraine but does not cause visual disturbance or vomiting.
What causes greater occipital neuralgia?
Greater occipital neuralgia may result from various factors that irritate, compress or inflame the occipital nerves, including:
- Neck tension or muscle tightness: Often related to other causes of neck pain causing local muscle spasm, which in turn, can lead to secondary greater occipital nerve compression/irritation with neuralgia.
- Trauma or injury: Whiplash or direct impact to the back of the head or neck, probably due to muscle spasm.
- Nerve entrapment: The greater occipital nerve may become compressed as it leaves the upper spinal column e.g. with facet joint arthritis/disc injury at the upper 3 cervical levels.
Common symptoms of greater occipital neuralgia
People with this condition may experience:
- Sharp, headache over one or both sides of the back or head: Often described as electric shock-like pain, which can refer over the top of the head to the forehead.
- Tenderness: Pain on pressure over the upper neck or base of the skull.
- Radiating pain: Discomfort that travels to the back of the head, scalp but radiates to the forehead or behind the eyes.
- Sensitivity: The scalp may feel tender or painful to touch, combing hair, or lying on a pillow.
Diagnosis of greater occipital neuralgia
Diagnosis of greater occipital neuralgia headaches begins with a thorough medical history and physical examination. Your specialist will ask about the location and quality of your pain—typically described as sharp, throbbing pain at the base of the skull that may radiate to the scalp, forehead, or behind the eyes.
During the physical exam, gentle pressure may be applied over the greater occipital nerve to see if it reproduces your symptoms. The doctor may also assess your neck mobility and look for muscle tightness or tenderness.
Imaging tests, such as MRI or CT scans, may be used to rule out other causes of head or neck pain, such as cervical spine disorders, tumours, or vascular conditions.
A diagnostic nerve block, in which a small amount of local anaesthetic often with corticosteroid is injected near the greater occipital nerve under image guidance, may be used to confirm the diagnosis. If pain relief is immediate and significant, it strongly suggests that the nerve is the source of the symptoms.
Management of greater occipital neuralgia
Treatment for greater occipital neuralgia focuses on relieving pressure on the nerve and reducing inflammation. Options may include:
- Physical therapy: To reduce muscle tension in the neck and improve posture.
- Medications: Anti-inflammatory drugs, muscle relaxants, or nerve pain medications.
- Occipital nerve blocks: Injections of local anaesthetic and steroid near the nerve can provide significant pain relief, which sometimes lasts for months. Botulinum toxin (Botox) can be injected to the local upper cervical muscles when muscle spasm is marked.
- Pulsed Radio Frequency Neurotomy: some pain management specialists and radiologists can perform this minimally invasive but relief is temporary lasting several months.
- Posture correction and ergonomic adjustments: Especially important for those with desk-based or repetitive activities.
- Surgical intervention: In extremely rare cases, surgery may be considered if other treatments fail.
