Neuromodulation in Cervicogenic Headache and Occipital Neuralgia

Abstract

Occipital neuralgia, also known as Arnold’s neuralgia, is a pathology that occurs in 0.1–4.7% of patients with cephalalgia [1]. It is defined by the International Headache Society (IHS) [2] as paroxysmal, shooting or stabbing pain lasting from a few seconds to minutes and starting in the occipital region before radiating within (and often beyond) the distribution of the greater occipital nerve (i.e., Arnold’s nerve, emanating from the C2 and C3 roots), lesser occipital nerve (emanating from the C2 root), or third occipital nerve (from the C3 root). These attacks are sometimes triggered by cold or by cervical movements. Tenderness to palpation of the emergence of the occipital nerve is frequently observed. The neurological examination was normal apart from occasional subjective anomalies (dysesthesia or hypoesthesia affecting a part of the scalp). Between attacks, there is occasionally a persistence of dull headache with variable characteristics (mimicking migraine, tension-type headache, cervical headache, or headache from overuse of analgesics, which are the main differential diagnoses). The syndrome is usually improved by infiltration of the nerve with local anesthetic. Cervicogenic headache (term introduced by Bovim et al. [3]) is precisely defined by the IHS as pain referred from the neck and perceived in one or more regions of the head and/or the face compatible with a cervical spine origin and can be abolished by a block of the cervical spine. But many chronic cervicogenic headaches became occipital neuralgias without efficient treatment and occipital neuralgias are frequently accompanied by tenderness of the neck muscles.