Occipital neuralgia is a rare headache disorder. It affects an estimated 3 out of 100,000 people each year, meaning fewer than than 250,000 people experience occipital neuralgia worldwide.

What is occipital neuralgia? Occipital neuralgia is a chronic pain disorder often grouped with headache disorders. This rare condition describes when headache pain starts at the top of your spine and spreads throughout your scalp. The head and neck pain is intense but brief.

This headache disorder feels like an electric shock or intense migraine, but only for a few seconds — maybe minutes. Migraine headaches last longer than occipital neuralgia and are much more common.

Occipital neuralgia is similar to trigeminal neuralgia, yet different from other headaches or migraines. Trigeminal neuralgia spreads pain throughout the front of your head and face, instead of the back of the head like occipital neuralgia.

Does chiropractic help occipital neuralgia? Yes, chiropractic may help occipital neuralgia. Upper cervical chiropractic adjustments can relieve occipital neuralgia pain, and some experts even claim that chiropractic treatment helps prevent occipital neuralgia from recurring and becoming chronic.

What are the symptoms of occipital neuralgia?

The 4 well-known symptoms of occipital neuralgia include:

  1. Brief, intense headache pain
  2. Longer-lasting, dull headache pain
  3. Light sensitivity
  4. Sensitivity to touch

What does occipital neuralgia feel like? Patients say occipital neuralgia feels “like there’s an ice pick being driven into my head.”

The defining characteristics of occipital neuralgia are where you feel headache pain:

  • Back of the neck
  • Top of the neck
  • Back of the head
  • One side of the head
  • Behind the ears
  • Scalp
  • Behind the eye

Is occipital neuralgia serious? Occipital neuralgia is not a life-threatening condition but may lead to serious impacts on your job productivity, school performance, and your overall quality of life. That’s why you should seek out treatment for occipital neuralgia if it flares up.

What causes occipital neuralgia?

Occipital neuralgia occurs when one or more of the occipital nerve roots (which are located at the top of your spinal cord) are inflamed or irritated. 90% of the time, occipital neuralgia happens when the largest of the nerves, the greater occipital nerve, is affected.

To truly understand how this works, you must briefly understand occipital nerve stimulation.

Occipital nerves are a group of nerves from C2 to C3. There are 3 occipital nerves:

  1. Greater occipital nerve
  2. Lesser occipital nerve
  3. Third occipital nerve

What may irritate or inflame occipital nerves to cause occipital neuralgia?

  • Injury to the neck (such as whiplash)
  • Muscle tightness
  • Infection
  • Gout
  • Diabetes
  • Tumors
  • Blood vessel inflammation
  • Cervical disc disease
  • Arthritis of the upper cervical spine
  • Nerve compression in the cervical spine

If your occipital nerves are already inflamed or irritated, touching the back of your head or neck may trigger occipital neuralgia. Even brushing your hair or bumping your head against a headrest may trigger it.

Tests & Diagnosis

To diagnose occipital neuralgia, a doctor may perform the following:

  • Symptoms checklist
  • Medical history
  • Family medical history
  • Physical examination
  • Ultrasound
  • MRI
  • CT scan
  • Blood tests
  • Nerve block

It is sometimes difficult to diagnose the cause of occipital neuralgia because it shares many symptoms with other types of headaches, such as migraines or cluster headaches.

A doctor may inject an occipital nerve block into the affected area, in order to diagnose occipital neuralgia. If the nerve block resolves your headache pain, then your occipital nerves are probably irritated or inflamed. 

Can occipital neuralgia be cured? No, occipital neuralgia cannot be cured in the traditional sense. Pain can be managed, and attacks can be prevented. If you can figure out the underlying cause of your occipital neuralgia and treat it, you should be “cured” as long as the underlying cause does not recur.

Treatment of Occipital Neuralgia

There are 9 treatment options for occipital neuralgia:

  1. Chiropractic care
  2. Massage therapy
  3. Over-the-counter medications
  4. Prescription drugs
  5. Injections
  6. Physical therapy
  7. Home remedies
  8. Surgery

Does occipital neuralgia go away? Occipital neuralgia may go away with time if the cause of your occipital nerve inflammation is corrected and maintained. 

1. Chiropractic Care

Occipital neuralgia is caused by inflammation or irritation of the occipital nerves. These nerves may be irritated by spinal misalignments, which chiropractors can correct.

Chiropractic care is the gentle manipulation of the spine, which can treat all types of headache pain. A common treatment of occipital neuralgia is chiropractic care and decompression, probably due to its non-invasive nature, as well as its non-reliance on side effect-heavy drugs.

Upper cervical chiropractic care is a great way to deal with headache pain while contributing to your overall health.

2. Massage Therapy

Massage therapy describes the gentle manipulation of muscles and soft tissues. Massages are often used to relax tight muscles, including muscles in your upper neck.

Since occipital nerves may be irritated by tight neck muscles, it’s no wonder that massage therapy has great potential in treating occipital neuralgia due to muscle tension.

Massage therapists sometimes use dry needling to treat muscle tension or chronic pain. Dry needling is essentially acupuncture, but based entirely on peer-reviewed research from the past few decades.

Recent research shows that both acupuncture and dry needling may improve clinical outcomes for occipital neuralgia patients.

3. Over-the-Counter Medications

Doctors may suggest over-the-counter medications for occipital pain relief.

Inflammation of your occipital nerves may cause occipital pain. But inflammation of surrounding muscles or blood vessels can pinch and irritate occipital nerves, resulting in a sort of secondary occipital neuralgia.

Ibuprofen (Advil) is a common anti-inflammatory medication for nerve pain management. It reduces inflammation that can lead to the shock-like pain associated with occipital neuralgia.

However, beware of the side effects of ibuprofen and similar drugs. Side effects of ibuprofen include:

  • Abdominal pain
  • Heartburn
  • Nausea
  • Vomiting
  • Gas
  • Diarrhea
  • Constipation

4. Prescription Drugs

Doctors may also prescribe prescription drugs to relieve occipital neuralgia pain, such as muscle relaxants, steroid injections, or antidepressants.

Muscle relaxants should relax the muscles around your occipital nerves, taking pressure off those nerves and offering occipital pain relief.

Anti-seizure meds, tricyclic antidepressants, and SSRIs (selective serotonin reuptake inhibitors) are all common prescription drugs used to treat occipital neuralgia. These all come with a laundry list of serious side effects, so it’s important to discuss these with your doctor before going this route.

5. Injections

Health care doctors may also administer injections to relieve occipital neuralgia. Since injections are more invasive than other treatments, these are often a last resort in the case that nothing else works.

Local anesthetic may be injected near the occipital nerves, bringing up to a year of occipital pain relief. (As long as you don’t treat the underlying cause, occipital neuralgia will likely return eventually.)

A 2018 meta-analysis shows that botox (botulinum toxin) injections may be a safe and effective treatment for occipital neuralgia.

6. Physical Therapy

Physical therapy is a common method of relieving occipital pain due to muscle tension, poor posture, or neck injury.

A physical therapist may instruct you on how to stretch or exercise so that your neck becomes stronger, yet less tense. They may educate you on exercises and stretches you can do to help with occipital neuralgia — first in a clinical setting, but late at home by yourself.

Chin tucks are the most common stretch for occipital neuralgia. Chin tuck benefits include:

  • Strengthening the neck
  • Reducing muscle tension
  • Improving posture
  • Stretching neck muscles

Discontinue any stretches or exercises that cause you pain.

7. Home Remedies

There are a few home remedies for occipital neuralgia. These are non-invasive, inexpensive, and side-effect-free.

Effective home remedies for occipital neuralgia include:

  1. Rest
  2. Warm compress
  3. Self-massage

You may also want to try all-natural anti-inflammatories that may reduce inflammation in or around your occipital nerves.

Consider trying these all-natural anti-inflammatories:

  1. Curcumin (turmeric)
  2. Cat’s claw
  3. Green tea
  4. Resveratrol
  5. Omega-3 fatty acids (fish oil)
  6. Capsaicin (chili pepper)
  7. Boswellia (AKA frankincense)
  8. White willow bark
  9. Maritime pine bark

8. Surgery

Surgical treatment attempts to correct several issues that may be triggering your occipital pain.

This is a more long-term occipital neuralgia treatment option, as opposed to the short-term solutions like ibuprofen. As long as you don’t address the root cause of your occipital neuralgia, it will come back.

Occipital release surgery involves making small incisions to un-pinch occipital nerves. Sometimes, inflamed tissue needs to be incised to release pressure off of your occipital nerves, in order to prevent future occipital neuralgia attacks.

If your occipital nerves are compressed due to osteoarthritis or rheumatoid arthritis, surgery may be used to ease the nerve pressure. Sufferers who choose this treatment often consult the American Association of Neurological Surgeons (AANS).

A ganglionectomy is a surgery meant to disrupt nerve clusters that may contribute to occipital pain.

Neurosurgeons may surgically place electrodes under your skin to stimulate the occipital nerves, or perhaps between your spinal cord and vertebrae. These electrodes are meant to block pain messages travelling through your nervous system.

In extreme cases, neurosurgery may sever the greater occipital nerve. This will lead to scalp numbness. 

Prevention

There are several ways to prevent inflammation or irritation of the occipital nerves that causes occipital neuralgia:

  • Exercise and stretch regularly.
  • Use good posture.
  • Avoid holding your head in a downward position for long periods of time.
  • If you experience muscle tension, try to relax the muscles and relieve the tension.
  • If you have an infection, get it treated before it irritates the nerves in your upper spine.
  • If you are injured in the neck area, seek medical attention to assess the damage.

If your occipital nerves are already inflamed or irritated, avoid touching the back of your head or neck, unless you have to. In that case, be very gentle.

Prognosis & Long-Term Outlook

Occipital neuralgia is a rare condition that affects a couple hundred thousand people every year across the globe. Although the pain is manageable, this disorder is not necessarily curable.
But with high-quality treatment, you can treat occipital neuralgia pain and even prevent future attacks.

If you are suffering from frequent headaches, consider upper cervical chiropractic care. At Denver Upper Cervical Chiropractic, we use evidence-based techniques to gently manipulate the spine. Most headache pain can be relieved with spinal adjustments.

Click here today to make an appointment with us!

Sources

  1. Djavaherian, D. M., & Guthmiller, K. B. (2019). Occipital Neuralgia. Full text: https://www.ncbi.nlm.nih.gov/books/NBK538281/
  2. Stall, R. S. (2013). Noninvasive pulsed radio frequency energy in the treatment of occipital neuralgia with chronic, debilitating headache: a report of four cases. Pain Medicine, 14(5), 628-638. Full text https://academic.oup.com/painmedicine/article/14/5/628/1816050
  3. Mallory, M., Bauer, B., & Chon, T. (2019). Occipital Neuralgia Treated With Acupuncture: A Case Report. Global Advances in Health and Medicine, 8, 2164956119890546. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883661/
  4. Bond, B. M., & Kinslow, C. (2015). Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia. The Journal of the Canadian Chiropractic Association, 59(2), 101. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486992/
  5. Choi, I., & Jeon, S. R. (2016). Neuralgias of the head: occipital neuralgia. Journal of Korean Medical Science, 31(4), 479-488. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810328/
  6. Meng, F., Peng, K., Yang, J. P., Ji, F. H., Xia, F., & Meng, X. W. (2018). Botulinum toxin-A for the treatment of neuralgia: a systematic review and meta-analysis. Journal of Pain Research, 11, 2343. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190814/
  7. Maroon, J. C., Bost, J. W., & Maroon, A. (2010). Natural anti-inflammatory agents for pain relief. Surgical Neurology International, 1. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011108/
Dr. Ty Carzoli
Dr. Ty Carzoli

Dr. Ty Carzoli is a certified doctor of chiropractic with several years of experience in pain management. He holds a Bachelor’s in Exercise Physiology from Florida State University, a Master’s in Sports and Health Medicine from Life University, and a Doctorate of Chiropractic from Life University. Dr. Carzoli is passionate about providing gentle, high-quality upper cervical chiropractic treatment to relieve pain and get patients back to living life to the fullest. He proudly owns and practices at Denver Upper Cervical Chiropractic.