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occipital neuralgia

a chronic pain disorder Etiology: 1) irritation or injury to the occipital nerve 2) physical stress, trauma, or repeated contraction of the muscles of the neck may contribute Clinical manifestations: 1) chronic disorder 2) pain originating at the nape of the neck a) pain in the distribution of the occipital nerve - may be said to spread up & around the forehead & scalp - may be unilateral base of the skull to the vertex b) throbbing & migraine-like - recurrent, paroxysmal - sharp or stabbing pain - associated with allodynia or dysesthesia & scalp tenderness c) worsened when supine or brushing hair Special laboratory: - response to occipital nerve block may support diagnosis - lack of response would suggest another diagnosis [3] Management: 1) treatment is symptomatic: includes massage & rest 2) antidepressants may be useful when the pain is severe 3) local nerve blocks & injections of steroids directly into the affected area may be diagnostic as well as therapeutic 4) occipital nerve stimulation [2] Prognosis: - pain is generally eliminated or reduced with treatment & does not interfere with daily activities

Related

occipital nerve

General

peripheral nerve disease; peripheral neuropathy neuralgia headache

References

  1. NINDS Occipital Neuralgia Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Occipital-Neuralgia-Information-Page
  2. Sweet JA, Mitchell LS, Narouze S et al Occipital Nerve Stimulation for the Treatment of Patients With Medically Refractory Occipital Neuralgia: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline. Neurosurgery. 2015 Sep;77(3):332-41. PMID: 26125672
  3. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Dougherty C. Occipital neuralgia. Curr Pain Headache Rep. 2014 May;18(5):411. Review. PMID: 24737457
  5. Barmherzig R, Kingston W. Occipital neuralgia and cervicogenic headache: diagnosis and management. Curr Neurol Neurosci Rep. 2019;19(5):20. PMID: 30888540 https://link.springer.com/article/10.1007/s11910-019-0937-8
  6. Urits I, Schwartz RH, Patel P et al. A review of the recent findings in minimally invasive treatment options for the management of occipital neuralgia. Neurol Ther. 2020;9:229-241 PMID: 32488840 PMCID: PMC7606364 Free PMC article https://link.springer.com/article/10.1007/s40120-020-00197-1