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Occipital Neuralgia


Purpose of Review

Occipital neuralgia is a painful condition that affects the posterior aspect of the head and can be difficult to distinguish from other common forms of headaches. This article reviews the anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for occipital neuralgia.

Recent Findings

Non-pharmacological treatments aim to alleviate muscle tension and improve posture. Acupuncture shows some promise. The occipital nerve block is considered the first line in a minimally invasive intervention, but the duration of relief may be short term. An onabotulinum toxin A injection may improve the sharp but not the dull component of the pain of occipital neuralgia. Radiofrequency ablation and occipital nerve stimulation may provide effective long-term relief in refractory patients. Surgical decompression, neurotomies, and neurolysis are last-resort treatment options.


Occipital neuralgia is a debilitating condition that can be difficult to treat. Studies with larger sample sizes and randomized control trials are needed to further determine the effectiveness and safety of different therapies.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Correspondence to Dalia Elmofty.

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Wenyu Pan, MD, Joanna Peng, MD, and Dalia H. Elmofty, MD, declare no conflict of interest.

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This article is part of the Topical Collection on Neuropathic Pain

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Pan, W., Peng, J. & Elmofty, D. Occipital Neuralgia. Curr Pain Headache Rep 25, 61 (2021).

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  • Occipital neuralgia
  • Nerve block
  • Neuropathic pain
  • Headache
  • Radiofrequency ablation
  • Peripheral nerve stimulation