Occipital neuralgia

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Occipital neuralgia
Classification and external resources
ICD-10 G52.8,[1] R51,[2] G44.847
ICD-9-CM 723.8

Occipital neuralgia, also known as C2 neuralgia, or (rarely) Arnold's neuralgia, is a medical condition characterized by chronic pain in the upper neck, back of the head and behind the eyes. These areas correspond to the locations of the lesser and greater occipital nerves. The greater occipital nerve also has an artery that supplies blood that is wrapped around it - the occipital artery - that can contribute to the neuralgia. This condition is also sometimes characterized by diminished sensation in the affected area as well.


Occipital neuralgia is caused by damage to these nerves. Ways in which they can be damaged include trauma (usually concussive), physical stress on the nerve, repetitive neck contraction, flexion or extension, and as a result of medical complications (such as osteochondroma, a benign tumour of the bone). Another rare but possible cause is CSF leaks.[3] Yet another cause is from radio frequency nerve ablation. Rarely, occipital neuralgia may be a symptom of metastasis of certain cancers to the spine.[4] There are several areas that have potential to cause injury from compression:

  1. The space between the vertebral bones of C1 and C2
  2. The atlantoaxial ligament as the dorsal ramus emerges
  3. The deep to superficial turn around the inferiolateral border of the obliquus capitis inferior muscle and its tight investing fascia
  4. The deep side of semispinalis capitis, where initial piercing can involve entrapment in either the muscle itself or surrounding fascia
  5. The superficial side of semispinalis capitis, where completion of nerve piercing muscle and its fascia again poses risk
  6. The deep side of the trapezius as the nerve enters the muscle
  7. The tendinous insertion of the trapezius at the superior nuchal line
  8. The neurovascular intertwining of the GON and the occipital artery


The main symptom of this condition is chronic headache. The pain is commonly localized in the back and around or over the top of the head, sometimes up to the eyebrow or behind the eye. Because chronic headaches are a common symptom of numerous conditions, occipital neuralgia is often misdiagnosed at first, most commonly as tension headache or a migraine leading to unsuccessful treatment attempts. Another symptom is the eyes being sensitive to light, especially when headaches occur.

Occipital neuralgia is characterized by severe pain that begins in the upper neck and back of the head. This pain is typically one-sided, although it can be on both sides if both occipital nerves have been affected. Additionally, the pain may radiate forward toward the eye, as it follows the path of the occipital nerve(s). Individuals may notice blurred vision as the pain radiates near or behind the eye. The neuralgia pain is commonly described as sharp, shooting, zapping, an electric shock, or stabbing. The bouts of pain are rarely consistent, but can occur frequently with some patients depending on the damage to the nerves. The amount of time the pain lasts typically varies each time the symptom appears; it may last a few seconds or be almost continuous. Occipital neuralgia can last for hours or for several days.

Other symptoms of occipital neuralgia may include:

  • Aching, burning, and throbbing pain that typically starts at the base of the head and radiates to the scalp
  • Pain on one or both sides of the head
  • Pain behind the eye
  • Sensitivity to light
  • Sensitivity to sound
  • Slurred Speech
  • Pain when moving the neck
  • Difficulty with Balance and Coordination
  • Tender scalp
  • Nausea and/or vomiting


Once diagnosed, occipital neuralgia's symptoms can be treated/managed in several ways. One of the most effective treatments is seeing a chiropractor, in which they adjust the subluxation in the atlanto occipital joint. When the occiput is out of alignment, the nerve and vascular supply can be cut off, as well as cause compression on the spinal cord. Once adjusted, the symptoms will diminish as the blood and nerve supply resume their normal movement in the body.

There are other wide range of non-invasive treatments, including physical therapy, rest, heat, anti-inflammatory medication, antidepressant medication, anti-convulsant medication, opioid and nonopioid analgesia, and migraine prophylaxis medication. Alternatives to these may include local nerve block, peripheral nerve stimulation, steroids, rhizotomy, phenol injections, antidepressants, and Occipital Cryoneurolysis.

Other less common forms of surgical neurolysis or microdecompression are also used to treat the condition when conservative measures fail.


  1. ^ "IHS - International Headache Society� IHS vs. ICD-10". Retrieved 2007-10-12.  replacement character in |title= at position 37 (help)
  2. ^ "NCCH ID". Retrieved 2007-10-12. 
  3. ^ Ansari, H.; Garza, I. (22 April 2012). "Occipital Neuralgia Secondary to a Spontaneous CSF Leak (P03.218)". Neurology 78 (Meeting Abstracts 1): P03.218–P03.218. doi:10.1212/WNL.78.1_MeetingAbstracts.P03.218. 
  4. ^ Moulding, HD; Bilsky, MH (Mar 2010). "Metastases to the craniovertebral junction.". Neurosurgery 66 (3 Suppl): 113–8. doi:10.1227/01.NEU.0000365829.97078.B2. PMID 20173512. 

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Liang, H. Occipital Neuralgia as a presenting symptom of gastic cancer metastasis. Imaging in Headache Medicine, April 2012. Saladin, Kenneth S. "Chapter 13: The Spinal Cord, Spinal Nerves, and Somatic Reflexes." Anatomy & Physiology: The Unity of Form and Function. 12th ed. New York, NY: McGraw-Hill, 2012. N. pag. Print.

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