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Occipitalis neuralgia: symptoms, cause and treatment

Occipitalis neuralgia is a type of headache characterized by a shooting, stabbing or pressing pain in the neck and in the back of the head (especially on the hard lumps). The pain can radiate towards the crown or ears, and sometimes behind the eyes. There may also be a reduced feeling in this area. Occipitalis neuralgia is caused by irritation or irritation of the occipital nerve. Often the exact cause is unknown. Risk factors of occipitalis neuralgia include trauma (damage) at the back of the head, compression (pinching) of the nerve due to tight neck muscles and osteoarthritis in the neck. Treatment of occipitalis neuralgia consists of physiotherapy, medication, injection of the nerve with corticosteroids and / or nerve root treatment, he has a good point

What is occipitalis neuralgia?

Occipitalis neuralgia is a neurological condition in which headaches occur because something presses on the occipital nerve and irritates the nerve. This leads to a disruption of the function of the occipitalis nerve and pain complaints: stabbing or pressing pain from the neck. This pain radiates over the skull. Occasionally you can feel the pain behind the eyes. This type of headache should not be confused with a migraine , muscle tension headache or other types of headache , because the symptoms may be similar.

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Appearance

The incidence of occipitalis neuralgia must still be accurately determined in 2018. A study among the Dutch population reported a relatively low incidence of 3.2 per 100,000 inhabitants.ยน Something more women than men have this condition. No time and season variation was found.

Symptoms of occipitalis neuralgia

Occipitalis neuralgia can cause a very intense pain that feels like a sharp, stabbing or stinging pain at the back of the head , especially on the hard lump, and the neck. The pain is often described as 'electric shocks'. Other symptoms of occipital neuralgia are:

Burning sensation and throbbing pain that typically begins at the base of the head and radiates to the scalp;

Pain on one or both sides of the head;

Pain behind the eyes ;

Sensitivity to light;

Sensitive scalp; and

Pain when moving the neck.

Cause of occipitalis neuralgia

Occipitalis neuralgia may result from compression or irritation of the occipital nerves due to injury (eg, a blow), cramping of the occipital nerve by, for example, neck tension, by repeated stress on the upper cervical vertebrae, or inflammation. Often no cause is found.

Risk factors

There are many medical conditions that are associated with occipitalis neuralgia, including:

Trauma at the back of the head;

Neck tension and / or tight neck muscles;

Osteoarthritis (this changes the cartilage with complaints such as stiffness and joint pain );

Tumors in the neck;

Degenerative disease of the cervical spine;

Infection;

Congenital abnormalities;

Gout ;

Diabetes ; and

Blood vessel inflammation.

Research and diagnosis

Interview and physical examination

If you suspect that you suffer from occipitalis neuralgia, make an appointment with your doctor. The doctor will ask you a number of questions about your medical history, any injuries you have suffered and your complaint pattern. In addition, the general practitioner will perform a physical examination. He will press around the back of your head at places where the occipital nerve is running, to see if he can reproduce your pain. He will also examine the movements of the neck and shoulder for possible limitations and painfulness. The general practitioner will also examine which vertebrae are hurt when he presses them.

Neurological research

In addition, a neurological examination is often required in order to exclude other causes. By completing the pain questionnaires, research can be conducted into any other non-physical (psychological or social) factors that may be related to your pain complaints. Making an X-ray of the neck can sometimes be necessary to exclude other causes.

Treatment of occipitalis neuralgia

The treatment of occipitalis neuralgia is via (a combination of) pain relief, physiotherapy, medication and / or nerve root treatment.

Physiotherapy

Physiotherapy can help improve muscle tone in your neck and your posture.

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Treatment with medicines

Nerve pain can be treated with pain medication:

Antineuropathic pain medication, for example tricyclic antidepressants;

Anti-epileptics, such as carbamazepine, gabapentin or pregabalin.

Injection of the nerve with corticosteroids

Treatment can be done by injecting a local anesthetic, possibly combined with a long-acting anti-inflammatory medicine, a corticosteroid (adrenal cortex hormone). This has an irritation-inhibiting effect. This injection is done at the height of the underlying occipital nerve. Because of this treatment the pain will decrease.

PRF treatment of the nerve root

Within the four weeks following this treatment, the occipital nerve may be treated with pulsed radiofrequency current (PRF), where heat is generated (42 degrees) which acts on the nerve. This treatment in which current with small impacts is given at the same time, can lead to a reduction in pain management over the affected nerve.

Prognosis

Occipital neuralgia can last for a long time, but can stop after a while. In general, occipitalis neuralgia is a long-term condition that requires treatment to reduce pain.

Prevention

In many cases, the cause of occipital neuralgia is not found, so it is difficult to determine how this condition can be prevented. However, recognizing factors that cause or contribute to the muscle tension in the neck and avoiding circumstances that can lead to neck injuries is a good start.