What Is Occipital Neuralgia?

by Mark McLaughlin, MD, FACS, FAANS

Occipital neuralgia is a distinct type of headache characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side of the head. It is often misdiagnosed. Dr. McLaughlin is expert in the diagnosis and treatment of occipital neuralgia

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Occipital neuralgia is an irritation of the greater occipital nerve, characterized by pain in the back of the head, behind the ear, radiating up to the top of the head/ sometimes behind the eye.

Most of your feeling in the back and top of your head is sent to the brain by the two greater occipital nerves. There is one of these nerves on each side of the head. The nerves emaerge from between the bones of the spine in the upper neck, and then the occipital nerves make their way through the muscles at the back of the head and into the scalp. Occasionally, the occipital nerve reaches almost to the forehead, but the nerves do not cover the face or the area near the ears; other nerves supply these regions.

Often times it is the result of a trauma such as a whiplash or a bad head injury, but it can also occur spontaneously.

What causes Occipital Neuralgia?

Some common causes include:

• Compression of the space between the vertebral bones of C1 and C2
• Compression of the atlantoaxial ligament as the dorsal ramus emerges
• Compression of the deep to superficial turn around the inferiolateral border of the obliquus capitis inferior muscle and its tight investing fascia
• Compression of the deep side of semispinalis capitis, where initial piercing can involve entrapment in either the muscle itself or surrounding fascia
• Compression of the superficial side of semispinalis capitis, where completion of nerve piercing muscle and its fascia again poses risk

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