A common cause of undiagnosed headache is occipital neuralgia
What is occipital neuralgia and how does it manifest itself? Explained by a pain specialist, founder of the clinics "Clinic Agatas" in Kaunas and Klaipėda, and a physician Asta Mažeikaitė-Banevičienė. Occipital neuralgia is a condition in which the occipital nerve is irritated. Clinically, it is most often manifested by a sharp, shooting, burning pain in the back of the head. The pain may radiate to the top of the head, the temple, or even to the eye. Some patients describe the sensation as if a “helmet” were being put on or numbness of the skin of the back of the head.
This pathology is very often confused with migraine, although scientific research shows that these two conditions can overlap, and migraine is often accompanied by occipital neuralgia.
Why does this diagnosis so often go undiagnosed?
The biggest problem is that occipital neuralgia cannot be confirmed by radiological tests, neither magnetic resonance imaging nor computed tomography. Therefore, patients often go for a long time without a clear diagnosis.
We, pain doctors, diagnose this condition based on clinical symptoms and by performing a diagnostic “block.” We locate the occipital nerve under ultrasound guidance and inject a local anesthetic. If the pain is significantly reduced or completely gone within about an hour, this confirms the diagnosis of occipital neuralgia.
What causes occipital neuralgia?
It is most often related to cervical spine problems and muscle tension. When the neck muscles spasm, they irritate the occipital nerve and cause pain. This is especially true for patients who have sedentary jobs, are exposed to chronic stress, or have poor posture.
How is occipital neuralgia treated?
Once the diagnosis is confirmed, complex treatment is applied. Physiotherapy and neck exercises are very important, so patients are referred to physiotherapists for consultation. Acupuncture is also very important, as it helps relax spasmed muscles, improve blood circulation, and reduce nerve irritation.
If the diagnostic "blockade" gives a good effect, we can also apply invasive procedures: occipital nerve "blockade" with steroids or cryodenervation, where cold affects the nerve fibers and suppresses pain impulses for a longer period of time. In some cases, the so-called "blockade" of the stellate node is also discussed.
Additionally, intravenous ozone therapy is very suitable for occipital neuralgia pain, and is widely used worldwide due to its ability to activate metabolism, improve tissue oxygenation, and help muscles relax.
What is the role of physiotherapy in treating occipital neuralgia? – answers physiotherapist and trainer Janina Bukantaitė:
In the case of occipital neuralgia, physiotherapy is focused on restoring the function of the cervical spine, reducing muscle imbalance and nerve irritation. Individually selected exercises and physiotherapy measures help not only to reduce pain, but also to correct its cause. When working with patients, we try to strengthen muscles, improve incorrect posture and thus reduce nerve pressure. Our goal is not short-term relief, but long-term prevention so that the pain does not recur.
And what can acupuncture help with? – we ask physiotherapist and acupuncture specialist Viktorija Preikšaitė:
Acupuncture helps to relax tense muscles, calm the nervous system and improve blood circulation. In the case of occipital neuralgia, this is especially important, because often the pain is supported not only by mechanical irritation of the nerve, but also by general overwork and stress of the body. The acupuncture procedure is safe, aimed at reducing tension in the trigger points and neck muscles of the occipital region and stimulating the occipital nerve.
By combining acupuncture, physiotherapy, and methods used by a pain doctor, very good long-term results can be achieved.
When should you contact specialists?
If headache or back pain recurs, gets worse, changes in nature, or does not respond to conventional treatment, we recommend consulting with pain specialists.