Pain in the back of the head? It could be occipital neuralgia

Medical Review by Zubair Ahmed, MD

Have you been diagnosed with Migraine, but Migraine-related medications and treatments aren’t helping? Does most of your pain begin in the back of your head? It may help you to learn more about Occipital Neuralgia (ON), a headache disorder associated with nerves located in the back of the head that can be misdiagnosed as Migraine.

The disorder is often confused with Migraine because of predominant overlapping symptoms. However, the gold-standard Migraine treatment, triptan medications, may not touch it. Here’s what you need to know and what to look for to understand the difference between the two.

Where Occipital Neuralgia and Migraine Overlap

Although Occipital Neuralgia is a relatively rare headache disorder, affecting an estimated 3.2 people per 100,000 each year, it’s worth knowing about because the primary symptom—occipital pain—is also a very common Migraine symptom. It’s also possible that due to the symptom overlap, there are more sufferers than we know of due to misdiagnosis. Both disorders manifest in occipital pain with similar severity, however, Migraine-associated pain lasts much longer.

Key Components of Occipital Neuralgia

Although, the overlap feels huge, ON has a range of more specific symptoms that can help you tease out whether your occipital pain is Migraine-related or could benefit from a different treatment plan. Here are some key components of ON to help you decide if it worth taking to your doctor further about occipital neuralgia 1 2

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Occipital pain: extremely common among people with Migraine, this pain stems from discomfort in the occipital nerves, which run from the base of the skull to the forehead.

Quality of pain: a sharp, piercing, stabbing pain starting at the back of the head, near the base of the skull that can radiate forward into the scalp and forehead.

Location of pain: on one or both sides of the head and/or moving to the forehead.

Occurrence of pain: pain while moving neck and aggravated by touching the area with activities including wearing a hat, or lying on a pillow.

Duration of pain: spells are episodic and last seconds to minutes, while migraines last substantially longer. They can recur throughout the day.

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Diagnosis criteria: an exam includes pressing on occipital nerves to elicit pain and although more conservative treatment measures might be taken first, temporary relief will come from the injection of a local anesthetic along the affected nerve.

Causes: relatively unknown, although nerve entrapment and irritation, as well as pain related to traumas such as whiplash, inflammation, or nerve compression by arteries or tumors, have all been hypothesized

Treating Occipital Neuralgia

Beyond the variation in symptoms and duration of pain, ON and Migraine attacks are caused by two very different things, and therefore may require different treatment pathways. Because ON is caused by nerve pain, which sends unpleasant sensations through the back of the head, it may not respond to triptans, the most commonly prescribed abortive medications for migraines.

Treatment options include conservative applications such as warm compresses, massage, and physical therapy. Prescriptive medication to alleviate and prevent pain include anti-inflammatories, muscle relaxers, antiepileptic drugs, and tricyclic antidepressants.

If first-line methods fail to dissipate discomfort, then patients can opt to try nerve blocks injected into the occipital region with a local anesthetic 3. Although commonly reported side effects include dizziness, lightheadedness, and soreness at the injection site, relief is often immediate but there is a variable duration of benefit from a couple weeks to months. If pain does not respond to the above measures, pulsed radiofrequency and occipital nerve stimulation procedures have shown promise.

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Occipital Nerve Blocks Can Help Migraine, Too

Occipital nerve blocks can even help some patients relieve Migraine pain since the occipital nerves are so heavily involved in an attack. So, if you’ve experienced some relief with a nerve block, it doesn’t necessarily mean you have occipital neuralgia. Occipital neuralgia typically won’t respond to rescue Migraine treatment, though, so it is important to get an accurate diagnosis and follow the treatment plan recommended by your doctor.

Comments? Have you been diagnosed with occipital neuralgia?

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The post How to Know if You Have Occipital Neuralgia appeared first on Migraine Again.



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