Occipital neuralgia: why does it occur and how to treat it?

Occipital neuralgia is characterized by severe pain in the back of the head. In most cases, it has its origin in underlying diseases that inflame or compress the nerve.

According to an article published in National Center for Biotechnology Information, this condition represents 8.3% of cases of facial pain. In addition, it is estimated that its incidence is 3.2 per 100,000 people. Do you want to know more about it? Keep reading!

Symptoms of occipital neuralgia

Occipital neuralgia is characterized by sharp, stabbing or stabbing pain that can occur continuously or intermittently. Of course, is located in the posterior portion of the skull, called the "occipital region."

The sensation follows the path of this nerve, which originates at the cervical level and ascends through the trapezius muscle. After this, it becomes a little more superficial and spreads its branches throughout the entire region.

Sometimes, even though the pain is well defined, it can radiate to any other part of the head. It is usually accompanied by abnormal sensations such as tingling, which is known from a medical point of view as "paresthesias."

Symptoms may worsen if pressure is placed on the exact point where the nerve emerges through the trapezius muscle (Arnold's point). This is considered a "trigger zone", present in several pathologies that are characterized by neuromuscular pain.

It occurs more frequently in women and tends to be unilateral, that is, it feels only on one side of the body. The mean age is 54.1 years, although it can occur earlier.

Occipital neuralgia causes throbbing pain that can be prolonged or intermittent.

Find out more: What are the causes and symptoms of chronic pain?

Causes of occipital neuralgia

Occipital neuralgia tends to be, in most cases, a secondary pathology. This means that there are other conditions or underlying diseases that altered the proper functioning of the nerve. On the other hand, primary cases, due to defects intrinsic to the occipital nerve, are almost non-existent.

There is a wide variety of conditions that can generate the clinical picture. These are capable of injuring or compressing the nerve in any part of its path, which is called pain of neuropathic origin. This, in turn, is usually caused by the unique anatomical characteristics of the occipital nerve.

In particular, this disease can be caused by the following:

  • Muscle contractures, especially of the trapezius muscle and the sternocleidomastoid.
  • Head injuries.
  • Cervical sprains
  • Cervical hyperextension.
  • Herpes simplex virus infection.
  • Diabetic neuropathy.

They are very diverse conditions that, as you will see later, require their own treatment to prevent the disease from progressing. Of this group, we will highlight herpes simplex virus infection and multiple sclerosis.

The first causes a condition known as postherpetic neuralgia. The herpes virus, after producing the primary infection, can remain within some nerves without causing damage. After many years, in the face of stressful or immunosuppressive events (such as receiving steroid treatment), the virus can reactivate and cause severe pain.

In the case of multiple sclerosis, it is an autoimmune, inflammatory and chronic disease, characterized by the progressive destruction of the layer that covers the nerves, called myelin sheath. This is necessary for an adequate conduction of electrical impulses, and if it is destroyed, it can irreversibly affect some neurons.

Discover more: Types of herpes

When to go to the doctor?

If the symptoms appear abruptly and seriously compromise the quality of life, it is advisable to go to an emergency service, where a symptomatic treatment will be indicated and the first pertinent studies will be carried out.

The symptoms are also likely to be not too bothersome, but to occur relatively frequently. In that case, it is advisable to plan a consultation with the doctor as soon as possible, who could refer to another specialist if he considers it necessary.

In any case, it is best to seek professional help at any time during the illness. There are few cases in which symptoms improve spontaneously, and if they happen, relapses of the same disease may occur.

How is it diagnosed?

Physicians, especially neurologists, have clinical rating scales to determine with a certain degree of certainty the diagnosis of occipital neuralgia. To do this, they usually take into account the following clinical criteria, according to the International Headache Society:

  • The aforementioned characteristics of pain, including the unilateral distribution of the occipital nerves.
  • Sensitive problems, such as pain triggered by gently touching the scalp.
  • The presence of "trigger zones" such as Arnold's point.
  • Partial or total improvement with anesthetic blocks of the occipital nerves.

Therefore, complementary studies are not usually required to reach an accurate diagnosis. In very specific cases, the doctor may order the following studies to determine the causes of the disease:

  • Complete blood count.
  • Blood chemistry, highlighting the levels of glycemia and glycosylated hemoglobin.
  • Computed tomography.
  • Nuclear magnetic resonance.

The neurologist performs a physical examination and assesses the symptoms according to the criteria of International Headache Society.


It is preferable to start with pharmacological treatments capable of reducing symptoms. In refractory cases, surgical interventions are valid options with excellent results.

Non surgical

Although commonly used pain relievers such as ibuprofen (within the group of non-steroidal anti-inflammatory drugs) may be effective, they are not the drugs of choice. There is a group of specific medications for this type of pain, which include the following options:

  • Pregabalin.
  • Gabapentin.
  • Garbamazepine (anticonvulsant drug).

They have good therapeutic effects, despite the fact that the frequency of adverse reactions can be high. Pregabalin, for example, can cause drowsiness, gastrointestinal disturbances, and decreased ability to react.

Injection of local anesthetics, such as lidocaine, can relieve occipital neuralgia much faster and without adverse effects, as long as there is a good technique. It is a cheaper solution than other surgical alternatives, and is performed on an outpatient basis.


In refractory cases, there are some alternative therapies, such as the following:

  • Radio frequency thermoregulation. By emitting electromagnetic waves, it is possible to reduce the sensation of pain through a minimally invasive process. It is easy to perform and has few associated complications.
  • Surgical nerve decompression. Here, the goal is to separate it from any structure that could be injuring it throughout its journey.

Prevention of occipital neuralgia

The best way to avoid a case of occipital neuralgia is to avoid the associated risk factors. In patients with a tendency to muscle contractures, Relaxation techniques and muscle relaxants may be helpful when localized pain is present.

Those subjects who suffer from chronic diseases (such as diabetes mellitus and multiple sclerosis) require adequate control of the underlying disease to prevent the appearance of this type of complications.

It is important to seek care

In case of presenting any of the aforementioned symptoms, it is best to go to the primary care doctor, who will carry out the initial assessment. In specific cases, you might refer to a neurologist or neurosurgeon. According to the presentation of the symptoms and their recurrence, the professional will determine the most appropriate treatment.