Occipital neuralgia is caused by impairment, inflammation, or stress on the occipital nerves, resulting in burning or stabbing headaches in the back of the head. It can be diagnosed through MRI or nerve blocking, and treated with pain-reducing medications or nerve destruction procedures. Conservative treatment is often effective.
There are two nerves that travel across the back of the head and are called the occipital nerves. Impairment, inflammation, or stress on one or both of these nerves and many other conditions can lead to occipital neuralgia. This causes headaches especially in the back of the head and other symptoms which can be very difficult to bear.
The pain experienced with this condition is often described as burning or stabbing, and can start in the neck, travel towards the back of the skull, and usually branch off one side of the head towards the eye. The occipital nerves do not affect the front of the head, so a headache that is located on the forehead or face is unlikely to be occipital neuralgia. However, the condition has been compared to migraine in other respects.
Although pain most often affects one side of the head, it can affect both if both occipital nerves become irritated or involved. Other types of pain or tenderness may also be associated with this condition. This includes making the skin and the surface of the head sensitive so that touching it for things like grooming or shampooing becomes extremely difficult due to the discomfort.
There are many potential causes of this condition, including tightness or tension in the neck caused by things like repeatedly keeping your head down (perhaps typing on a laptop). Traumatic injuries to the neck or head could damage one of the occipital nerves, or some forms of arthritis of the cervical spine can put pressure on the nerve. Cervical spine tumors could have a similar result. Sometimes people with diabetes get this condition and another cause could be certain forms of infection. In many cases, there is no explanation for the inflammation of the occipital nerves.
Diagnosing occipital neuralgia can be done in several ways. Doctors, usually neurologists, might do magnetic resonance imaging (MRI) or computed axial tomography (CAT scans), to see if there are any potential lesions or blockages present in the cervical spine or neck. Another way this condition is often diagnosed is by performing a nerve block on the occipital nerve suspected of creating the problem. This causes the nerve to go completely numb, temporarily, and if occipital neuralgia is the cause of a patient’s pain, nerve blocking typically relieves the pain and confirms the diagnosis.
Once a patient has been diagnosed, the question of how to treat the condition more permanently remains. There are several potential treatments, and if doctors determine a direct cause, they may have a better idea of how to proceed. Many begin with nonsurgical conservative treatment methods, which might involve giving pain-reducing medications. The most common choices are nonsteroidal anti-inflammatory drugs (NSAIDs) and medications such as Tegretol®, Neurontin®, or sometimes certain antidepressants. The use of heat and neck massage can also prove beneficial.
When the pain is long-lasting and resists treatment with medications, doctors might suggest some pain relief methods that will destroy or damage the occipital nerve to reduce the pain. This has the unfortunate side effect of leaving one part of the head numb, but for many, there is nothing better than being subjected to constant pain. These procedures, including cutting or burning the nerve, will usually only be employed if a patient has responded well to an occipital block. Many people don’t need surgery to repair occipital neuralgia and may respond well to more conservative treatment.
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