J Korean Med Sci.  2016 Apr;31(4):479-488. 10.3346/jkms.2016.31.4.479.

Neuralgias of the Head: Occipital Neuralgia

• Choi I
• Jeon SR

• KMID: 2363684
• DOI: http://doi.org/10.3346/jkms.2016.31.4.479

Abstract

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

Keyword

Occipital Neuralgia; Third Occipital Nerve; Greater Occipital Nerve; Lesser Occipital Nerve; Cervicogenic Headache

MeSH Terms

Anesthetics/therapeutic use
Botulinum Toxins/therapeutic use
Electric Stimulation
Humans
Magnetic Resonance Imaging
Nerve Block
Neuralgia/*diagnosis/surgery/therapy
Spinal Nerves/anatomy & histology/*physiopathology
Steroids/pharmacology
Anesthetics
Botulinum Toxins
Steroids

Figure

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  Fig. 1 Anatomy around occipital nerve; Asan medical illustration team modified this figure with permission from Shane Tubbs (91).

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  Fig. 2 Mechanism of cervicogenic headache: pain referred pain from cervical structures due to convergence between trigeminal nerve and C1, 2, 3 verves in trigeminocervical nucleus.

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  Fig. 3 Landmarks for injection of the occipital nerves and electrical stimulation; Rogier Trompert Medical Art, modified with permission from Vanelderen et al. (9).

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  Fig. 4 Treatment algorithm for ON.

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