Today we will tackle a common term used in headache medicine, which is occipital neuralgia; a diagnosis that is commonly mentioned by headache specialists, yet without clear explanation of its meaning and implications.
What is “neuralgia”?
Neuralgia is a description of a specific type of pain; which is sharp, severe, shooting as if electrical and brief. Most importantly, it follows a known nerve course. Since pain nerves are also sensory nerves, it is common to have tingling or numbness along the course of the nerve as well.
Neuralgia pain is identical to the type of pain that happens when you hit your funny bone in your elbow and you get that electrical shock down your fingers.
Neuralgia usually occurs because of a dysfunctional nerve, either due to irritation (such as compression by a nearby structure), infection (such as shingles) or inflammation along its course. The most commonly known neuralgia is trigeminal neuralgia, which happens when the trigeminal nerve (which innervates half the face) becomes irritated and starts sending severe stabbing pain signals down its course.
What is the occipital nerve?
The occipital nerves are a set of three nerves on each side; the greater, the lesser and the third. They originate from the cervical spinal cord, travel near the cervical spine joints and then traverse to the top of head.
The occipital nerves are sensory nerves, meaning they are responsible for touch and pain sensation on the back of head.
The true “occipital neuralgia”
A real occipital neuralgia originating from a dysfunction of the nerve itself is not common in our experience. A true occipital neuralgia pain should come as a repetitive sharp shooting pain from the back of the head, feeling like stabbing or electrocuting; at times with tingling/numbness along with it as well.
A true occipital neuralgia will be intermittent, happening on and off, and leaving little or no discomfort in between.
The common “occipital neuralgia”
In the majority of patients, “occipital neuralgia” is a term that used to describe an occipital headache accompanied by tenderness over the nerves. This term is used even if the pain is not “neuralgia-like” as described above.
In practice, this occipital neuralgia is most commonly seen in two scenarios:
Patients with frequent migraines: If you follow my blogs, you know that migraine is truly a disease of hypersensitivity. Migraine patients are overly sensitive to any sensory stimulation, light, noise, smells and/or pain. This happens because migraine lowers the threshold needed for our nerve cells to fire. Hence, what may not bother a normal individual, can be quite annoying and augmented in someone with a migraine. This same applies to the occipital nerves. Migraine can irritate all scalp nerves and make them tender, the occipitals included. Hence, many migraine patients may feel tenderness on the back of their head.
Cervicogenic headache: The occipital nerves originate near the joints of cervical spine segments. If these joints or nearby muscles irritated, then the occipital nerves will frequently transmit this irritation. Actually, the occipital nerves are the reason people with neck pain have headache. In this case, the occipital tenderness and pain is not truly due to a problem in the nerve, as much as it is a response to the pain in the original structures in the neck, where the nerve comes from. This pattern of pain is called a referred pain in medical terminology.
Understanding these differences in occipital neuralgia is imperative if one wants to understand how to best address that pain, but that is for another day.
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