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Monica,

What are some treatments for Occipital Neuralgia?

First, it’s important to distinguish if you’re actually having a migraine or if it may be occipital neuralgia. The treatments are different for each.

According to experts at Cleveland Clinic, occipital neuralgia can feel like a migraine, but it isn’t one. It’s a nerve induced headache and requires a different approach to treatment.

So what’s the difference?

According to the American Migraine Foundation, (and anyone who has ever had one) a migraine is not just a bad headache. It’s actually a disabling neurological disease with different symptoms and different types of treatment. AMF estimates about 39 million Americans suffer from migraines, but that number is likely higher because many are never actually diagnosed.

Common symptoms vary person to person but can include:

  • Pain may occur on any part of the head or multiple parts (front, back, left, right or a combination)
  • Some people have pain in and around their eyes and behind their cheeks
  • The pain pulses, throbs or pounds
  • Gets worse with any movement
  • Causes nausea, vomiting, light sensitivity, noise sensitivity or smell sensitivity
  • Pain is intense enough to cause you to miss school, work or activities
  • Pain lasts for hours and even days

Some people experience an aura with a migraine. Often it’s visual, such as flashes of light, blind spots, shapes or bright spots. The aura can also impair vision and usually starts before the head pain.

Causes of migraine are still being studied, but genetics and environment can have an impact. Triggers can include stress, certain foods, skipping meals, alcohol, irregular sleep, the weather, hormones and brain injury.

Migraines are more common in women. If you think you are suffering from recurring migraines, start keeping a headache journal. Try to note as many specifics as possible and then share it with your doctor.

There are two types of migraine treatments, acute and preventative. Preventative treatments could be medications or procedures, such as Botox injections, but also lifestyle changes, trigger avoidance and behavioral therapy.

Acute treatments are usually medications you take when you experience an attack. These can include over-the-counter pain relievers or prescription medications.

If your migraine medication isn’t working, you may be suffering from occipital neuralgia.

Occipital neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed. This causes headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears.

The symptoms are similar:

  • Aching, burning or throbbing from the base of your head up to your scalp
  • Sharp, shock-like or piercing pain in your upper neck and back of your head
  • Pain on one or both sides of your head
  • Pain behind your eyes
  • Tender scalp
  • Pain when moving your neck

But according to Cleveland Clinic pain management specialist Dr. Shrif Costandi, that’s where the similarities end because the sources of pain are different. Migraines are related to changes in the brain. Occipital neuralgia is caused by compressed or irritated nerves that run from the neck, up the back of the head to the scalp.

Muscle spasms or neck trauma such as whiplash can trap nerves and lead to occipital neuralgia and there are no identifiable triggers, such as auras or symptoms that occur before the headache.

Pain specialists can diagnose the difference based on the patient’s history. If the pain starts in the neck and radiates up the head to the eyebrows, that’s typical occipital neuralgia.

The doctor might be able to reproduce the pain by pressing on the occipital nerves at the base of the skull.

And if a nerve block works to numb the pain, it’s likely occipital neuralgia causing the headache.

According to the American Association of Neurological Surgeons, causes are different than migraine and can be the following:

  • Osteoarthritis of the upper cervical spine
  • Trauma to the greater and/or lesser occipital nerves
  • Compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes
  • Cervical disc disease
  • Tumors affecting the C2 and C3 nerve roots
  • Gout
  • Diabetes
  • Blood vessel inflammation
  • Infection

Oral inflammatory medicines are usually the first round of treatment. But using heat or massage to ease tight neck muscles can also help.

Advanced treatment options could include muscle relaxants, anticonvulsant medications, nerve blocks and Botox injection.

There are also surgical options including:

  • Occipital nerve stimulation: Electrodes are placed under the skin near the occipital nerves. The procedure works the same way as spinal cord stimulation and uses the same device. The procedure is minimally invasive and surrounding nerves and structures are not damaged by the stimulation. It is an off-label indication for a Food and Drug Administration-approved device.
  • Spinal cord stimulation: this surgical treatment involves the placement of stimulating electrodes between the spinal cord and the vertebrae. The device produces electrical impulses to block pain messages from the spinal cord to the brain.
  • C2,3 Ganglionectomy: This treatment involves the disruption of the second and third cervical sensory dorsal root ganglion. A 2008 study found that 95% of patients had immediate relief with 60% maintaining relief past one year.

Bottom line: If the headache is lasting more than three months and won’t respond to normal treatments, including migraine medication, you need to see a doctor.


Monica Robins is the Senior Health Correspondent at 3News. The information provided in this column is for educational and informational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this column or on our website.

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