Occipital Neuralgia
Causes, Symptoms, and Treatments

Occipital neuralgia causes pain that is felt in the back of your neck and head. It may radiate along one or both sides of your head, and you may feel pain behind one or both eyes. The pain can be sharp and severe and prevent most normal activities.






You may get some relief with rest in a dark quiet room which can confuse the diagnoses. Occipital pain is often misdiagnosed as a migraine or other type of headache.

The Occipital Nerves

There are three Occipital nerves on each side of your head. They are the Greater Occipital Nerve, the Lesser Occipital Nerve, and the Least Or 3rd Occipital Nerve.

They innervate the scalp around the back of your head.

These nerves come out of the spinal canal just below your skull. They pass through the trapezius and other muscles in the back of your neck and then run up into your scalp.

They can sometimes be felt along the base of your skull and if they are inflamed or injured even light pressure will cause severe pain.

Causes of Occipital Neuralgia

Occipital neuralgia is caused by injury or irritation of the occipital nerves. This can occur after trauma such as a blow to the back of the head or neck. Osteoarthritis or degenerative discs in your cervical spine and pressure from tight muscles are also common causes.

Other less common causes include tumors in your neck causing pressure on the occipital nerves, gout, diabetes, and vasculitis or inflammation of the blood vessels in that area.


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Symptoms of Occipital Neuralgia

Pain is the most common symptom of occipital neuralgia.

People often describe it as a burning, aching, throbbing kind of pain that starts at the top of the back of your neck that radiates up onto the back of your head. It may also radiate up onto the side of your head or be felt behind your eye on one side or the other.

You may be sensitive to light and there may be tenderness at the top of your neck just below the back of your skull. Your scalp may also be sensitive anywhere around the back of your head.

Looking up at the ceiling can make your pain worse.

Occipital neuralgia is a common cause of neck and head pain. The pain can sometimes be very severe and debilitating, making it impossible for people to carry on even normal activities. It is often confused with migraine headaches and other causes of a headache pain.

Occipital Neuralgia Treatments

This nerve pain is caused by injury or irritation of one or more of the occipital nerves. 

Finding the best treatment will depend on exactly what is causing the nerve irritation, and how severe and limiting the pain is. 


If you have been in an accident or suffered a blow to the back of your head or neck you need to be seen by your doctor. He can evaluate you and order the correct x-rays to check for a more serious injury.


Heat or cold packs may help if your pain is caused by inflammation of the blood vessels or muscles around the occipital nerves. This inflammation can cause a chemical irritation of the nerves. Over the counter anti-inflammatory drugs such as naproxen or ibuprofen can also be helpful.

Muscle Entrapment

If the occipital nerves are being irritated by pressure from tight muscles, stretching exercises and gentle massage may help to relieve your pain. With massage, you will need to be very careful because any pressure on the occipital nerves may make the pain worse.

When the Pain is More Severe

When conservative treatments are not helpful and do not allow you to return to normal activities you may need to contact your doctor and consider more aggressive treatments.

Your doctor can treat you with: 

• Muscle relaxants to release tight muscles.

• Antiseizure drugs to calm irritated nerves.

• Antidepressant medications work more centrally in your brain to relieve pain.

• Nerve blocks or steroid injections to relieve the inflammation and swelling.

More Aggressive Treatments Include Surgery

Microvascular Decompression

When your doctor thinks your pain is being caused by blood vessels around the occipital nerves he may send you to a surgeon. A surgeon can adjust and reroute the vessels that appear to be irritating the nerves.

Occipital Nerve Stimulation

These electrical units are implanted under the skin. Similar to a TENS unit, neurostimulation uses very low voltage electrical stimulation to block the pain signal from reaching your brain. You may feel a light buzzing or tingling sensation, but these units can be very effective for relieving pain.

Occipital Neuralgia is not Life Threatening

Neuralgia can cause pain that is very severe. It can prevent normal activities and make it very difficult for you to live your life, but people do not die from occipital neuralgia.

If you continue to have pain you need to discuss it with your doctor. He may refer you to a neurologist or other specialists who can order further studies to check for other less common causes of your pain.



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