by Dr. Michael Horowitz

Occipital neuralgia (ON) feels like a sharp pain involving the scalp on one side of the back of the head. Occipital neuralgia pain is located along the path of the occipital nerve. Occipital neuralgia pain is described as sharp, sudden and severe pain although it may be more chronic with an ache involving the back of the scalp.

Occipital neuralgia symptoms also accompanied by decreased sensation to pinprick and touch on that side of the scalp. Patients with Occipital neuralgia may at times report pain behind their eye on the same side of the head where they have scalp pain. While ON can occur spontaneously, it is often generated by touching or pushing on the scalp or upper neck.

What causes occipital neuralgia to flare up? Occipital Neuralgia may arise spontaneously for no apparent reason. At other times, however, Occipital Neuralgia can occur after some type of traumatic injury. This could include a blow to the back of the head or neck or sudden twisting and turning of the head and neck. Twisting of the head and neck that occurs after a motor vehicle accident is often a contributing factor to the development of Occipital Neuralgia. This can occur either immediately or in a delayed fashion.

Treatment options

How do you know if you have occipital neuralgia? It is often difficult to determine if a patient's scalp pain is due to Occipital neuralgia. For this reason, when a patient experiences symptoms that may be due to Occipital neuralgia, the surgeon will often first inject a region in the back of the scalp or the area of the spine where the nerves travel or arise with a temporary anesthetic agent to block the nerve from functioning. This block will cause temporary numbness to one side of the scalp. If that numbness relieves the patient’s reported discomfort and pain, and if the discomfort and pain return after the temporary anesthetic agent wears off, then the patient will be offered more definitive therapy.

These treatments for Occipital Neuralgia can include surgical cutting of the nerve so that it no longer functions or electrical stimulation of the nerve or electrical heating and burning of the nerve so that it no longer functions.

There are so many different causes for occipital neuralgia make it difficult to determine a cure rate for the condition. Nevertheless, if a patient is completely cured from the pain following an injection with a temporary anesthetic agent, then there is greater than 60% likelihood that their pain will be permanently relieved or improved by a surgical procedure that cuts the nerve as it exits the spine.

Dr. Michael Horowitz, Neurological Surgeon