Occipital neuralgia

Occipital Neuralgia or Arnold’s Neuralgia

is a type of intense, throbbing headache that originates in the greater occipital nerve. This nerve is responsible for the sensation of the scalp at the back of the head. When irritated or inflamed, it can cause a sharp, stabbing pain, often described by the patient as “a prick or electric shock” in the back of the head, behind the ears and sometimes in the neck. Occasionally small movements of the head may worsen the pain and is accompanied by increased sensitivity in the scalp.

How is it diagnosed?

Diagnosis is based primarily on the symptoms described by the patient, as well as a detailed physical examination. On examination, pressing on the nerve distribution triggers pain similar to that experienced by the patient. It may be accompanied by altered sensation in the scalp on the same side. In addition, a cranial and cervical spine MRI is usually performed to evaluate whether there are structural lesions that may involve the nerve. In most patients this study is normal.

How is it treated?

The treatment of choice is the anesthetic occipital nerve block. It is a simple procedure that is performed in the office on an outpatient basis. It consists of the injection of a local anesthetic and a corticosteroid in the occipital region. The improvement of pain is usually immediate and confirms the diagnosis.

In those cases that do not improve with anesthetic blockade, oral drugs such as gabapentin, pregabalin, carbamazepine and amitriptyline are used. The disadvantage of this treatment compared to anesthetic blocks is that they often have side effects such as dizziness, unsteadiness or drowsiness.

What can you do?

If you have frequent pain in the back of your head or neck, accompanied by symptoms such as shooting pain, scalp tenderness or pain that increases with certain movements, it is important to see a specialist. Early treatment can help you control the pain and prevent it from getting worse. .