Occipital Neuralgia - Symptoms, Diagnosis & Treatments

Occipital neuralgia describes a form of nerve pain with a resultant headache. The disorder is caused by compression or irritation to the lesser, and or, greater occipital nerve. The greater occipital nerve extends from the cervical spine to the back of the head, innervating areas of the scalp.

occipital neuralgiaMillions of people across the globe are affected by headaches everyday – most of us will experience a headache at some point in our lives. Some headaches however, such as those resulting from occipital neuralgia, can be excruciatingly painful and debilitating.


Typical symptoms include stabbing, burning, aching and shooting pain usually felt in the posterior scalp. Other less common reported symptoms include pain felt behind the eye, the temple, frontal regions and around the neck – pain can be either bilateral or unilateral.

Certain movements may further aggravate the painful symptoms such as neck movement or rotation of the neck.

Although not a common condition, occipital neuralgia is not gender specific, affecting both men and women equally at no particular age range.


A thorough physical and neurological examination will be needed with a CT or MRI scan – these are often used for testing. In some cases, a peripheral nerve conduction study may be useful.

Patients with occipital neuralgia often go undiagnosed – it can be difficult to distinguish it from other forms of headaches as the symptoms mimic those of other headache conditions such as the common migraine.

It may be confused with the following headache disorders:

  • Migraine
  • Tension
  • Cluster
  • Cervicogenic

Migraine, Tension and Cluster headaches are all categorised as primary headache disorders. Cervicogenic headaches are secondary headaches, these have an underlying cause such as a tumour, infection or trauma. Occipital neuralgia may be a primary or secondary headache disorder.


There are a variety of potential causes:

  • Injury / trauma – a car accident for example may cause irritation or injury to the lesser and or greater occipital nerve
  • Tumour or infection may affect the nerve roots
  • Degenerative cervical spinal changes, such as arthritis may result in nerve compression
  • Cervical disc related problems
  • Severe tightening of the cervical muscles can also cause nerve entrapment


Depending on the severity and any underlying cause of the symptoms, different treatment courses may be taken.

These may include:

Pain Medication

Anti-inflammatory medication, opioids and anti convulsants can be beneficial in the relief of painful symptoms.


Physiotherapy and massage are possible forms of treatment for occipital neuralgia.

Occipital Nerve Blocks

An occipital nerve block is an injection composed of steroid and local anaesthetic applied around the occipital nerve for temporary pain relief. The effect of the injection varies from patient to patient – for some it may be very effective, lasting up to several months, for others only a few days. However there are a handful of patients which may not experience any relief at all.

Occipital Nerve Stimulator Implantations

Another pain relieving treatment which may be considered if the patient has failed conservative therapies – it involves the surgical implantation of a subcutaneous electrode along the occipital nerve.

Surgical Decompression

In the majority of cases patients undergoing any form of micro vascular decompression for occipital neuralgia have exhausted every other possible form of treatment. Micro vascular decompression involves adjusting any blood vessels which may be impinging on and compressing nearby nerves. The offending blood vessel is usually separated from the nerve with a tiny piece of sponge, therefore relieving the painful symptoms.

Pain Management Clinic

An accurate diagnosis is critical to the success of any subsequent treatment – this begins with a specialist physician. Suffering from chronic pain is a daily challenge, a pain management consultant works closely with other pain management professionals providing patients with a treatment plan tailored to suit individual needs.

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