What is Occipital Neuralgia?

Occipital Neuralgia causes a sharp, intense, shock-like pain in the back of the head. It occurs when the occipital nerve becomes trapped.


The characteristic symptom of occipital neuralgia is sharp, shock-like pain in the back of the head. This pain can last anywhere between a few seconds and several hours. Between episodes of sharp pain a dull ache is common, in addition to generalised pain in the back of the head and tenderness around the area.


Occipital Neuralgia is often caused when the occipital nerve, which travels along the neck and up to the base of the skull, becomes trapped. Activities such as brushing hair or lying with your head on a pillow can trigger an attack. Many cases of Occipital Neuralgia occur due to chronic neck tension.


Treatment of Occipital Neuralgia aims to alleviate pain, there is no definitive cure. There are two categories of treatment, surgical and non-surgical. The non surgical route of treatment involves a variety of interventions such as:

  • Using a heat pad

  • Physical therapy or massage therapy.

  • Oral Medication: Anti-inflammatory medications; Muscle relaxants; and Anticonvulsant medications.

  • Percutaneous nerve blocks: these injections can be used both to diagnose and treat occipital neuralgia.

  • Botulinum Toxin (Botox) Injections: Botox injections can be used to decrease inflammation of the nerve

However, if non surgical interventions do not produce successful results, a surgical route may be more appropriate. Surgical interventions used to treat Occipital Neuralgia include:

  • Occipital Nerve Stimulation: This surgical treatment involves the placement of electrodes under the skin near the occipital nerves. The procedure works the same way as spinal cord stimulation and uses the same device. The procedure is minimally invasive and surrounding nerves and structures are not damaged by the stimulation.

  • Spinal Cord Stimulation: this surgical treatment involves the placement of stimulating electrodes between the spinal cord and the vertebrae. The device produces electrical impulses to block pain messages from the spinal cord to the brain.

  • C2,3 Ganglionectomy- This treatment involves the disruption of the second and third cervical sensory dorsal root ganglion. Acar et al (2008) studied the short-term and long-term effects of this procedure. The study found that 95% of patients had immediate relief with 60% maintaining relief past one year.


Occipital Neuralgia is tricky to diagnose as there is no concrete test, however a variety of methods may be used to diagnose the condition. A physical examination and neurological exam may be done to look for abnormalities. If the physical and neurological exams are inconclusive, a doctor may order further imaging to rule out any other possible causes of the pain. A magnetic resonance imaging (MRI) test may be ordered, which can show three-dimensional images of certain body structures and can reveal any impingement. A computed tomography scan (CT or CAT scan) will show the shape and size of body structures. Some doctors may use occipital nerve blocks to confirm their diagnosis.

Living with Occipital Neuralgia

Occipital Neuralgia is a flare symptomatic condition, this means that it has periods of little to no symptoms, and periods of extenuated and extreme symptoms. There are several things I have found which extenuate my symptoms, these include: extensive screen time, slight head trauma (knocks and bangs of the head), and bright light, or loud noise. Occipital Neuralgia is a manageable condition for me, I know that if I take my medication on time and maintain a routine alternating rest and work, my symptoms will remain managable.

For more information on Occipital Neuralgia, please visit:

The American Association of Neurological Surgeons

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