Occipital neuralgia: Anatomic considerations

Abstract

Occipital neuralgia is a debilitating disorder first described in 1821 as recurrent headaches localized in the occipital region. Other symptoms that have been associated with this condition include paroxysmal burning and aching pain in the distribution of the greater, lesser, or third occipital nerves. Several etiologies have been identified in the cause of occipital neuralgia and include, but are not limited to, trauma, fibrositis, myositis, fracture of the atlas, and compression of the C-2 nerve root, C1-2 arthrosis syndrome, atlantoaxial lateral mass osteoarthritis, hypertrophic cervical pachymeningitis, cervical cord tumor, Chiari malformation, and neurosyphilis. The management of occipital neuralgia can include conservative approaches and/or surgical interventions. Occipital neuralgia is a multifactorial problem where multiple anatomic areas/structures may be involved with this pathology. A review of these etiologies may provide guidance in better understanding occipital neuralgia.

Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2

“…21 In addition, many proposed sites of GON compression by vascular, muscular, or osteogenic causes are at the level of the cervical spine or upper cervical nerve roots. 2,4,22,23 The results of this study suggest that anesthetizing the nerve at a more proximal location, closer to these potential areas of compression, may result in improved analgesic effect.…”

“…After emerging from the suboccipital triangle, the nerve courses cephalad in an oblique trajectory between the semispinalis capitis (SC) and obliquus capitis inferior (OCI) muscles. [1][2][3] This area has been recognized as a potential location for GON injury and entrapment. 4,5 The nerve then passes through the trapezius muscle and courses medial to the occipital artery as it ascends to innervate the posterior scalp.…”

“…4,5 The nerve then passes through the trapezius muscle and courses medial to the occipital artery as it ascends to innervate the posterior scalp. [1][2][3] According to the International Headache Society (IHS), a local anesthetic block of the GON can aid in the diagnosis and treatment of occipital neuralgia. 6 Moreover, GON blocks have shown efficacy in the diagnosis and treatment of cervicogenic headache.…”

Cervical plexus and greater occipital nerve blocks: controversies and technique update

“…The GON originates from the medial cutaneous branch of the dorsal ramus of the C2 spinal nerve, with variable contribution from the C3 dorsal ramus 5. After branching off the C2 dorsal ramus, the GON travels inferiorly between the arch of the C1 vertebra and the lamina of the C2 vertebra and around the caudal margin of the oblique capitis inferior muscle (OCIM),6 although in some cases it may pierce through the inferior part of the OCIM.…”

Practical considerations of linear accelerator‐based frameless extracranial radiosurgery for treatment of occipital neuralgia for nonsurgical candidates

“…Occipital neuralgia is a neurological condition characterized by paroxysms of intense pain transmitted by the greater occipital nerves in the back of the head and neck often accompanied by a dull ache . The condition is differentially diagnosed from other headache types by using patient descriptions of the pain, noting the location of tenderness associated with pain episodes, and achieving prompt relief of pain following an anesthetic block of the greater occipital nerve .…”