Occipital neuralgia presents as a distinctive headache often felt in the upper neck, the base of the head, or behind the ear and usually occurs on only one side. Some may also feel pain in the scalp, forehead, or behind the eye(s). It is a rare condition in which the occipital nerves become inflamed or injured generating a pain that may feel like a migraine. Occipital nerves are located on each side of the head and run from the top of the spinal cord up through the scalp. If these nerves become inflamed or irritated, something as simple as the stroking or brushing of hair can trigger pain.
Symptoms of occipital neuralgia include, but are not limited to, pain behind the eye(s); scalp sensitivity; pain that tends to shoot from the back of the skull toward the eye; numbness of the affected area; sensitivity to light; pain when moving the neck; and sharp, throbbing, burning pain that starts at the base of the head and moves towards the scalp. Although the most severe symptoms of occipital neuralgia are brief, the pain is generally very powerful and sharp. However, occipital neuralgia is not life-threatening.
Osteoarthritis can cause compression of the occipital nerves as they leave the spine resulting in occipital neuralgia. Other causes include trauma to the back of the head, a pinched nerve near the bottom of the neck, injury, skull surgery, muscles tightness, tumors, gout, diabetes, and prolonged periods of keeping the head tilted downward and/or forward. Although anything that causes pressure or irritation to the occipital nerves can cause occipital neuralgia, oftentimes, a specific cause is not determined.
No single test exists that can give an absolute diagnosis of occipital neuralgia. A health professional can perform a thorough physical examination which includes pressing firmly around the back of the head to determine if the pain can be reproduced. The doctor may perform an occipital nerve block; in which case, if the pain subsides, a diagnosis of occipital neuralgia is determined.
Rest, massage, heat therapy, muscle relaxants, and anti-inflammatory medication offer relief to some while others may respond well to steroid injections that calm the occipital nerve. If further treatment is required, occipital release surgery may be performed. This is generally an outpatient procedure in which a small incision is made at the location of the occipital nerve; the nerve is then released from the tissue or muscle that is compressing it. This surgery has proven to be successful, and full recovery ranges from one to two weeks. If no relief is given from the occipital release surgery, further surgery may be required as a last resort. Additional surgery would include cutting the occipital nerve which would result in permanent scalp numbness.