Occipital Neuralgia With and Without Migraine: Difference in Pain Characteristics and Risk Factors

Abstract

There may be significant differences in pain characteristics for patients with ON + M and those for patients with isolated ON. The data indicate that patients with migraine should also be screened for symptoms of ON, as there may be similarities in presentation. The clinical implications of distinguishing ON + M and isolated ON include differences in treatment regimen, avoidance of inappropriate use of medical resources, and differences in long-term outcomes.

Pain is more widespread and referred to trigeminal areas in occipital neuralgia

“…The outcome in the current study is in accordance with previous investigations 2, 3,6,19 indicating that neuropathic features including a burning, throbbing and shooting quality, presence of a sub-occipital pain generator area, numbness, jabbing, dizziness and a positive response to local anesthetic blocks, are clinical characteristics of ON. It is noteworthy to mention that even though ON is typically a neuropathic pain, only 21.8% of ON patients in the current study described their pain as electric-shock like.…”

“…ON is a very difficult headache to diagnose due to the variety of signs it presents with 3 , and is also much more common than other cranial neuralgias, and occurs in the distribution of the second or third cervical dorsal roots. ON pain is described together with paresthesia in the occipital nerve distribution 4,5 , as a paroxystic, lancinating pain located to the occipital skin area supplied by the GON, sometimes accompanied by dull, continuous pain 6 .…”

Differentiating occipital neuralgia from migraine and tension-type headache

“…These symptoms could be used by the novice and experienced clinician to establish a diagnosis and differentiate ON from MWA. This assumption and observations are echoed by other investigations 2,6,18,22 indicating that ON is a true neuropathic pain described in the sub-occipital, frontal, temporal, and orbital areas of the head. MWA and ON are headache pains described as very intense, with the presence of many autonomic symptoms.…”

“…The etiology of ON is related with a multiplicity of factors including whiplash injury, compression of the GON between the atlas, axis and upper cervical roots by arthritic changes in the spine 6 , severe trauma to the greater or lesser occipital nerves, degenerative spinal changes, cervical disc disease and tumor affecting C2/C3 nerve roots 2 . Clinically, ON is described as unilateral or bilateral paroxysmal, lancinating, stabbing or shooting, throbbing, burning, intermittent, electric-shock like, continuous and/or intermittent pain of moderate to severe intensity, usually short lasting, with diminished sensation in the distribution of the GON and/or lesser occipital nerves, presenting with a pain generator area in the occipital/sub-occipital region associated with a tender local area, pain reproduced with pressure over the pain generator area, and usually radiating to the vertex, frontal, orbital, and peri-orbital regions 2,4,6 .…”

“…Clinically, ON is described as unilateral or bilateral paroxysmal, lancinating, stabbing or shooting, throbbing, burning, intermittent, electric-shock like, continuous and/or intermittent pain of moderate to severe intensity, usually short lasting, with diminished sensation in the distribution of the GON and/or lesser occipital nerves, presenting with a pain generator area in the occipital/sub-occipital region associated with a tender local area, pain reproduced with pressure over the pain generator area, and usually radiating to the vertex, frontal, orbital, and peri-orbital regions 2,4,6 . In many cases, pain in ON is so intense that radiation to the neck and face is reported frequently and may be disabling and refractory to conventional treatment 7 .…”