Neuralgias of the Head: Occipital Neuralgia

Abstract

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

Occipital neuralgia in lung carcinoma: A rare clinical scenario case report

“…Tumour and radiotherapy aetiologies were excluded. After a detailed discussion in a multispecialty clinic, none of the rare causes published in literature could be identified as precipitating cause in this case (9). Following exclusion of common as well as rare but reported causes, drug induced occipital nerve neuropathy was considered as probable aetiology.…”

C1-C4 Dorsal Column Stimulation for Refractory Occipital Neuralgia Treatment. Case Report

“…3 If refractoriness occurs, performing a neurectomy or a gangliectomy 4 are options with controversial results, because they can worsen the painful condition. 1 In this case, the patient had already taken anesthetic blocks with corticosteroids, with improvement only while the effect of the anesthetic lasted. The patient underwent an open surgery for neurectomy, but she showed no improvement after 3 months.…”

“…Another advantage of dorsal cord stimulation at this level is the anatomical characteristic of the cervical plexus and the occipital nerves with numerous anastomoses as well as the possibility of activation of adjacent cervical spinal areas and trigeminal nuclei. 1,4 The greatest negative point of the technique presented is the port site of the surgery; the procedure should be performed by a neurosurgeon with knowledge of the anatomy of the occipital and cervical regions. The postoperative period was well-tolerated by our patient, with a good pain control outcome.…”

Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management

“… 1 A GON block is commonly performed to provide anesthesia and analgesia to the occipital area. 2 , 3 Especially, a positive response to a GON block is necessary to establish a diagnosis of occipital neuralgia. 3 – 5 In the modern ultrasound era, GON blocks performed under ultrasound guidance have gained popularity in clinical practice.…”