Occipital Neuralgia

Pain Practice Volume 10 Issue 2, Pages 137 - 144
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
8. Occipital Neuralgia 
Pascal Vanelderen, MD, FIPP*†; Arno Lataster, MSc ‡ ; Robert Levy, MD, PhD § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP**; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Pain and Palliative Care Medicine, University Medical Centre Radboud, Nijmegen, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands
Correspondence to Maarten van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl 
KEYWORDS

ABSTRACT

Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major and/or nervus occipitalis minor. The pain originates in the suboccipital region and radiates over the vertex. A suggestive history and clinical examination with short-term pain relief after infiltration with local anesthetic confirm the diagnosis. No data are available about the prevalence or incidence of this condition. Most often, trauma or irritation of the nervi occipitales causes the neuralgia. Imaging studies are necessary to exclude underlying pathological conditions. Initial therapy consists of a single infiltration of the culprit nervi occipitales with local anesthetic and corticosteroids (2 C+). The reported effects of botulinum toxin A injections are contradictory (2 C±). Should injection of local anesthetic and corticosteroids fail to provide lasting relief, pulsed radio-frequency treatment of the nervi occipitales can be considered (2 C+). There is no evidence to support pulsed radio-frequency treatment of the ganglion spinale C2 (dorsal root ganglion). As such, this should only be done in a clinical trial setting. Subcutaneous occipital nerve stimulation can be considered if prior therapy with corticosteroid infiltration or pulsed radio-frequency treatment failed or provided only short-term relief (2 C+).