Neck (Cervical)
Occipital Neuralgia
후두신경통
Occipital headache caused by irritation of the occipital nerves
- How common
- Relatively common
- Typical age
- All ages
What is it?
Irritation or compression of the greater or lesser occipital nerve produces neuralgic pain radiating from the occiput to the vertex.
Commonly affected: Distribution of the greater occipital nerve (C2) and lesser occipital nerve (C3).
How it develops
- Triggers of nerve irritationMuscle tension, cervical joint problems, or trauma compress or irritate the nerve.
- Nerve hypersensitivityThe occipital nerve becomes hypersensitive and generates abnormal pain signals.
- Radiating painPain radiates along the C2 distribution from the occiput to the vertex and behind the eye.
Symptoms
- Stabbing occipital painSharp, electric-shock-like pain lasting seconds to minutes.
- Scalp hypersensitivityPainful with hair or pillow contact (allodynia).
- Radiation to the vertexPain radiates from the occiput to the vertex and behind the eye.
- Worse with neck motionWorsens with neck rotation or flexion.
How it is examined
- Occipital tendernessMarked tenderness just below the occiput at the greater occipital nerve exit point.
- Tinel signTapping the nerve exit point reproduces an electric-shock sensation.
- Pain relief after nerve blockImmediate pain relief after an occipital nerve block confirms the diagnosis.
Imaging
X-ray is obtained to evaluate underlying structural causes.
- Usually normal
- May show cervical degenerative change
MRI is used to rule out secondary causes (tumor, vascular compression, etc.).
- Normal in primary occipital neuralgia
- Important to exclude secondary causes
Non-surgical care
- Occipital nerve blockGreater occipital nerve injection with steroid + local anesthetic — the fastest and most effective treatment.
- AnticonvulsantsCarbamazepine or gabapentin for neuralgic pain control.
- Tricyclic antidepressantsAmitriptyline for chronic neuralgia prevention.
- Physical therapy / massageRelaxation of cervical musculature reduces nerve compression.
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
When all conservative measures have failed.
Procedures that may be discussed
- Occipital nerve stimulation
- Nerve decompression / neurolysis
Outlook
Most patients improve immediately with nerve blocks. If pain recurs, repeat injections or preventive medications are used.