What is Occipital Neuralgia?

Understanding Occipital Neuralgia

Occipital neuralgia is a condition that affects thousands of individuals worldwide. In this blog post, we will delve into this diagnosis so you will have a clear understanding of what occipital neuralgia is, its causes, symptoms, diagnosis, treatment options (including self-management), and the impact it can have on individuals’ lives. 

First, what is Occipital Neuralgia?

Occipital neuralgia is a neurological disorder characterized by chronic pain originating from the occipital nerves, which run from the base of the skull up to the scalp. These nerves provide sensation to the back of the head, scalp, and neck region. Occipital neuralgia typically manifests as burning, stabbing, sharp, or shooting pain. Symptoms are often felt shooting up the back of the head and are commonly one-sided. 

Now, you may intuitively feel the need to push or massage at the base of the skull where the irritation is felt. This is because there are 5 different muscle groups in this region of the neck, a portion of which are very small and only span across a couple of vertebrae. These smaller muscles, called suboccipital muscles, are responsible for smaller movements of the head, such as nodding and rotation, and offer stabilization. If there is dysfunction in the upper part of the neck, it increases tension in this muscle group. 

As far as nerves go, the greater occipital nerve is often the culprit when it comes to occipital neuralgia. This nerve pierces through muscles in the suboccipital region before traveling up into the scalp. So why would a nerve have pain? Nerves are designed to transmit information between a tissue within the body to the brain and vice versa. Nerves are mainly made to transmit signals, but sometimes the nerves themselves can be generating pain. There are a few different instances where a nerve can have an issue. First, it may be inflamed – inflammation around the nerve is going to sensitize the nerve itself. Second, the nerve may not have enough space. Ideally, it should be able to slide in between tissues as we move our bodies. If this is unable to occur (for example, due to increased muscle tension), it can create tension and hypersensitivity within the nerve itself. Finally, if we’re not moving the way we should, it can create both of the previously mentioned problems. This may be due to limited joint mobility or increased tension somewhere within the system that encourages our neck to compensate and move in different patterns.

Causes and Triggers:

While the exact cause of occipital neuralgia is not always clear, several factors can contribute to its development. The compression or irritation of the occipital nerves is commonly associated with the onset of this condition. Other possible causes and triggers may include:

  1. Trauma: Injuries such as whiplash, head trauma, or neck strain (for example, prolonged poor posture) can damage or cause compression on the occipital nerves and lead to the development of occipital neuralgia.
  2. Nerve entrapment: Compression or entrapment of the occipital nerves by tight muscles, scar tissue, or bony structures can result in neuralgia symptoms.
  3. Cervical spine disorders: Conditions like cervical disc herniation, degenerative disc disease, or cervical spondylosis can contribute to nerve irritation and subsequent neuralgia.
  4. Inflammation: Inflammatory conditions like arthritis or infections may cause inflammation of the occipital nerves, leading to pain.
  5. Genetic predisposition: Some individuals may have a genetic predisposition to developing occipital neuralgia, though further research is needed to fully understand this aspect.

Symptoms and Diagnosis:

Occipital neuralgia primarily manifests through severe pain localized in the occipital region, often radiating to the sides of the head or behind the eyes. Common symptoms include:

  1. Intermittent or constant throbbing pain at the back of the head or neck.
  2. Sensitivity to light or sound.
  3. Tenderness in the scalp.
  4. Pain triggered by neck movement or prolonged neck posture.
  5. Headaches resembling migraines.

Diagnosing occipital neuralgia can be challenging, as its symptoms can overlap with other headache disorders. A comprehensive evaluation by a healthcare professional is crucial to rule out other potential causes. Medical history review, physical examination, and diagnostic tests like nerve blocks or imaging studies may be employed to confirm the diagnosis.

Treatment Options:

The goal of effective treatment strategies for occipital neuralgia is to alleviate pain, reduce inflammation, and improve the overall quality of life. The following treatment modalities may be considered:

  1. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and anticonvulsants can help manage pain and inflammation. In some cases, nerve blocks with local anesthetics or corticosteroids may provide relief.
  2. Physical therapy: Targeted exercises, stretches, and posture correction techniques can help alleviate muscle tension and reduce nerve irritation.
  3. Nerve stimulation: Techniques like occipital nerve stimulation or pulsed radiofrequency ablation may be used in severe cases that do not respond to other treatments.
  4. Lifestyle modifications: Stress management techniques, relaxation exercises, and maintaining a healthy lifestyle can contribute to pain management.

Impact on Daily Life:

Occipital neuralgia can significantly impact an individual’s quality of life. Chronic pain, headaches, and associated symptoms may lead to physical discomfort, emotional distress, and limitations in daily activities. It is important for individuals living with occipital neuralgia to seek appropriate medical care, engage in self-care practices, and build a support network to manage the challenges this condition presents.

Our Approach:

As a team of manual physical therapists, our focus is on restoring movement and reducing tension throughout the upper neck, as well as addressing any other joints and tissues that may be contributing to the problem. Often, we emphasize mobility through hands-on techniques to improve the quality of movement, thus reducing unnecessary tension throughout supporting musculature. From there, we provide mobility and strengthening exercises for you to complete at home to maintain movement gained during a treatment session, as well as to progress on your own. We also take a close look at daily habits. Sitting is often an issue and where we can first look. Research shows that standing more often throughout the day can have a huge impact on our spine health. Standing with our weight between both feet allows our skeletal system to take the majority of the work to hold our heads up instead of relying on the muscular system. Another postural component we can consider is the head position. If your head is pushed forward, the neck muscles have to work a lot harder versus if you slide your head back. Getting hands-on, in-person treatment is also important. With physical therapy, this presentation is often fairly easy to treat with manual interventions and specific exercises to improve strength and mobility.

By raising awareness, fostering understanding, and providing education and self-management strategies, we can support those affected by this condition. If physical therapy sounds like the route for you on your journey to reduce pain, give our office a call today at (719) 598-1010.



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