Occipital Neuralgia – Causes, Symptoms and Treatment in San Francisco

Occipital Neuralgia

The occipital neuralgia is usually defined by the experts as a rare and specific type of headache which appears in the back of the head, behind the ears and the neck as a consequence of the occipital nerves inflammation or injury.

This disease is usually self-diagnosed as a migraine, so people do not receive a proper treatment and do not feel relieve. This is one of the main reasons why chiropractic doctors have dedicated themselves to diagnose and treat this condition to return the patient to an adequate quality of life.


The experts say that anything that can irritate the occipital nerves or cause an excessive pressure on them can cause occipital neuralgia. So, any injury in the muscles, ligaments, arteries and veins around the occipital nerves will cause the nerve inflammation.

The experts have found certain risk factors that can increase the chances of developing an occipital neuralgia. For example, a trauma in the back part of the head or upper part of the neck, a neck’s muscles inflammation which entraps the occipital nerves, osteoarthritis of the neck’s bones (this condition can facilitate the nerves compression when leaving the spine), tumors (or other type of cancer) in the neck and skull’s base, cervical discs diseases, infections, blood vessels inflammation, Diabetes, gout, among others.

Finally, in many cases, the doctors can’t find a specific cause, which is called idiopathic occipital neuralgia.

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As it was said before, occipital neuralgia is characterized by the presence of a chronic pain in the back of the head, skull’s base and surrounding areas where the nerves go through. The patients can use many words to describe the occipital neuralgia, including aching, burning, throbbing, sharp or stabbing pain or sensation.

The specific location and irradiation of this type of pain is due to the fact that occipital nerves supply the sensation from the posterior skull, the occiput, temporal areas, the vertex and the ears. At this point, it is also very important to highlight that occipital neuralgia symptoms always vary from a patient to another.

Other symptoms commonly referred by the patients include the irradiation of pain to one or both sides of the head (and even the face), retroocular pain (pain behind the eyes), photosensitivity (sensitivity to light) and hyperacusis (sensitivity to sounds).

Patients also refer that pain gets worse when moving the neck or touching the skin and scalp of the area, a condition called hyperalgesia. As these symptoms are very unspecific, it must be differentiated from a migraine, other types of chronic headaches (such as the trigeminal neuralgia) and even other conditions which affect the organs of the throat.

For example, the doctor must differentiate occipital neuralgia from the pain caused by the affection of the neck’s muscles, ligaments, arteries, veins, lymph glands and organs (thyroid and parathyroid glands, esophagus, larynx and trachea).



The anamnesis (or medical interrogation) and physical exam are very important because they can help the doctor to determine the severity and specific location of the pain, which is very important in the differential diagnosis. Asking about current medical conditions and prior injuries (or surgeries) is necessary to establish a proper diagnosis.

During the physical examination, the doctor will press the back of the head and the upper part of the neck firmly to prove that it triggers the pain. Just in atypical cases, or when the diagnosis is not totally clear, the doctor can ask for certain blood tests or an MRI scan to discard other conditions.

There is no a specific test to diagnose or confirm occipital neuralgia.

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Before explaining the occipital neuralgia treatment, it is very important to say that a proper diagnosis is needed because the different types of headache and other conditions that can be confused with this condition require different treatments. So, we always recommend consulting a qualified doctor.

The main objective of occipital neuralgia treatment is relieving the pain in the back of the head and neck. For this, the patient usually must use heat compresses over the affected area, take rest in a quiet room, undergo a massage (to relieve the neck and scalp muscles) and take certain anti-inflammatory drugs (over-the-counter or under prescription), such as naproxen or ibuprofen.

When these measures are not enough to relieve pain, the doctor can prescribe muscle relaxants, antiseizure drugs (like carbamazepine and gabapentin) and mild antidepressants.

Another option for treating occipital neuralgia is the nerve block, which can be defined as a shot applied by the doctor directly in the nerve to numb it. It can be used as a short-term treatment with a maximum of 2 to 3 shots for 3 or 4 weeks. However, only a qualified doctor can determine the proper scheme of treatment for each patient.

In the past years, chiropractic was considered an alternative treatment for occipital neuralgia. However, nowadays it is highly recommended for patients who do not feel a proper relieve with traditional treatments as an alternative to surgery. An important advantage of the chiropractic treatment is the fact that it treats the root of the problem and not only relieves the symptoms.

Among the most common treatments used by chiropractic doctors, lift adjustments, heat, massages and tractions can be included. These methods restore a proper spine alignment and help to relax the neck muscles, which eliminates the excess of pressure in the occipital nerves.

It is very rare for the patient to need to undergo surgery, but it can be recommended when he/she does not get better with the treatments mentioned above. When surgery is needed, it consists in a microvascular decompression, which means that the surgeon adjusts the blood vessels in the area and repairs the structures that might be compressing the occipital nerves.

Finally, it is important to highlight that, although occipital neuralgia is not considered a life-threatening condition, pain in the back of the head can result very disabling. So, it is always important to look for a qualified doctor.



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