Cervicogenic Headaches: Occipital Neuralgia

The pain of occipital neuralgia begins in the back of the head, usually on one side. As the pain gets worse it spreads upward, forward and to the the other side, sometimes involving the entire head.

Occipital Neuralgia is a type of posterior headache thought to be caused by a derangement of either the greater or lesser occipital nerves. The signs and symptoms are indistinguishable from other types of cervicogenic headaches and in all likelihood the primary lesion is not even in the occiput. It is currently felt that rather than being the cause of the problem the greater and lesser occipital nerves are merely serving as the final pathway for the expression of symptoms.

As with other posterior headaches the disease often progresses through a number of stages wherein the pain develops a more neuropathic quality over time. In its classic form the headaches are episodic, usually one sided and patients describe their pain as beginning over the occipital protuberance and then spreading superiorly and anteriorly to involve the entire scalp on the affected side. With increasing severity patients will complain of spread of pain to the contralateral side and pain behind the eye. Eventually the headaches become continuous and fixed with loss of anatomical specificity and disease free periods.

The diagnosis of occipital neuralgia was originally made by anesthetizing the greater and lesser occipital nerves and noting the patient’s response. The problem with this approach is that it is neither specific nor required for the diagnosis. Most posterior headaches will respond at least temporarily to occipital nerve blockade and in particularly sever or advanced cases patients will fail to respond at all. They will describe a totally numb hemicrainium and a complete persistence of their pain.

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