Occipital Neuralgia Headaches
The International Headache Society (IHS) defines occipital neuralgia as:
A paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves or of the third occipital nerve (nerves running up the back of the neck and head), sometimes accompanied by diminished sensation or dysaesthesia (abnormal sensation) in the affected area. It is commonly associated with tenderness over the nerve concerned.
Accordingly, the IHS specifically describes occipital neuralgia as a condition in which “pain is eased temporarily by the local anesthetic block of the nerve”. This supports the notion that the symptoms are primarily due to a “nerve trigger point” problem, as local anesthesia works on nerves to temporarily deaden them.
Occipital neuralgia causes similar problems to migraine headaches, but may respond very differently to certain forms of treatment. Both conditions can be initially treated with medication, yet many of our patients observe better lasting results with Botox® injections. Those who receive successful results from Botox® treatments may continue with a surgical procedure as an intended permanent way of reducing or eliminating their pain.
Many of our occipital neuralgia patients report the onset of the condition following a traumatic event, such as a car accident or fall. A whiplash injury that causes inflammation in the head and neck region may result in the occipital nerves becoming sites of these “trigger points”. Patients with this type of history tend to respond the best to injection therapy or even to trigger point decompression surgery.
Conversely, in patients with confirmed occipital neuralgia, we rarely see a patient who does not report some improvement from Botox®. The reason behind this may be connected to the fact that occipital neuralgia is a condition that is primarily due to “nerve trigger points” as opposed to migraines, in which the underlying problem may be due to a combination of factors.
Both occipital neuralgia and migraine headaches are initially treated with medication in an attempt to reduce symptoms and prevent or alleviate the occurrence of headaches. Although medical therapy can be very effective, for many headache sufferers medication can be less effective over time. If the side effects of the medical therapy outweigh the benefits, the individual may discontinue taking the medications, forced to deal with the consequences.
Q & A with Dr. Elkwood
Q: What is occipital neuralgia?
In occipital neuralgia, the occipital nerves that run from the top of the spinal cord up through the scalp are injured or inflamed, which is what causes the painful headache symptoms. In addition to pain, these headache sufferers can feel tenderness or diminished sensation around the area of the nerve.
Q: What is the difference between occipital neuralgia and migraine headaches?
While occipital neuralgia causes a jabbing pain in the area of the occipital nerve, migraines are characterized by recurrent headaches lasting 4-72 hours. Occipital neuralgia causes similar problems to migraine headaches, but may respond very differently to certain forms of treatment. Neurologists and other headache specialists sometimes have difficulty diagnosing the headache condition as one or the other, and there may be overlap in the classification. The bottom line is that there are 28 million migraine sufferers in the United States, one-third of whom find little or no benefit from traditional medical therapies.
Q: What are the differences in treatment for the two conditions?
Both occipital neuralgia and migraine headaches are initially treated with medication in an attempt to reduce symptoms and prevent their reoccurrence. Unfortunately, many medical approaches stop working over time. In addition, often these medications have side effects that can disrupt patient’s lives in unpleasant ways. Botox® injections can be helpful in treating both types of headaches, depending on each patient’s specific condition, and are particularly helpful for occipital neuralgia.
Q: What surgical options are available for these types of headaches
If patients benefit from Botox® therapy, Nerve Decompression Surgery is offered as a permanent way of reducing or eliminating headaches. This treatment is available at only a limited number of locations in the United States, with The Institute of Advanced Reconstruction being one of them. We have been performing this surgery since 2005 with tremendous success, especially in patients with occipital neuralgia.
Q: Can you describe Nerve Decompression Surgery?
This surgery involves a minimally invasive approach to the nerves in the head and neck region that cause or contribute to headache symptoms. The nerve sites are relieved when the surgeon removes muscle, tissue lining, and blood vessels from the areas in which the nerves travel. Multiple trigger point sites can safely be addressed in one procedure. The number of locations on which to operate depends on each patient’s symptoms, and in which locations Botox® therapy has been effective.
Q: Is Nerve Decompression Surgery successful in reducing symptoms?
Some of our patients have essentially been “cured” of their condition. This means they no longer need medical therapy and rarely, if ever, have a headache. Though each individual case varies, if you suffer from occipital neuralgia there is a good chance your symptoms would be helped by either Botox® or surgery.