Skip to main content

Representative Clinical Case: Occipital Neuralgia

  • Chapter
  • First Online:
Book cover Diagnosis and Management of Head and Face Pain

Abstract

The patient is a 44-year-old African-American female who presented with severe, lancinating occipital pain. Her medical history was notable for a motor vehicle collision resulting in a whiplash injury and a Chiari malformation for which she underwent decompression surgery. The pain was predominantly right-sided and described as constant, stabbing, and sharp and made worse with palpation and neck movement. The patient was neurologically intact on physical examination, although had a positive Tinel’s sign with exquisite tenderness to palpation over the greater occipital nerve on the right side predominantly, as well as the left side to some degree. She achieved notable but transient pain relief with selective occipital nerve blocks and transcutaneous electrical nerve stimulation. Anticonvulsant medications resulted in pain relief initially, but were less effective over time.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808. https://doi.org/10.1177/0333102413485658.

  2. Tobin JA, Flitman SS. Occipital nerve blocks: effect of symptomatic medication: overuse and headache type on failure rate. Headache. 2009;49:1479–85. https://doi.org/10.1111/j.1526-4610.2009.01549.x.

    Article  PubMed  Google Scholar 

  3. Tobin J, Flitman S. Occipital nerve blocks: when and what to inject? Headache. 2009;49:1521–33. https://doi.org/10.1111/j.1526-4610.2009.01493.x.

    Article  PubMed  Google Scholar 

  4. Johnstone CS, Sundaraj R. Occipital nerve stimulation for the treatment of occipital neuralgia-eight case studies. Neuromodulation. 2006;9:41–7. https://doi.org/10.1111/j.1525-1403.2006.00041.x.

    Article  PubMed  Google Scholar 

  5. Cesmebasi A, Muhleman MA, Hulsberg P, Gielecki J, Matusz P, Tubbs RS, Loukas M. Occipital neuralgia: anatomic considerations. Clin Anat. 2015;28:101–8. https://doi.org/10.1002/ca.22468.

    Article  PubMed  Google Scholar 

  6. Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep. 2001;5:382–6.

    Article  CAS  PubMed  Google Scholar 

  7. Vanelderen P, Lataster A, Levy R, Mekhail N, van Kleef M, Van Zundert J. 8. Occipital neuralgia. Pain Pract. 2010;10:137–44. https://doi.org/10.1111/j.1533-2500.2009.00355.x.

    Article  PubMed  Google Scholar 

  8. Cohen SP, Peterlin BL, Fulton L, Neely ET, Kurihara C, Gupta A, Mali J, Fu DC, Jacobs MB, Plunkett AR, Verdun AJ, Stojanovic MP, Hanling S, Constantinescu O, White RL, McLean BC, Pasquina PF, Zhao Z. Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness. Pain. 2015;156:2585–94. https://doi.org/10.1097/j.pain.0000000000000373.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery. 2006;58:112–119; discussion 112-119.

    Article  PubMed  Google Scholar 

  10. Weiner RL, Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation. 1999;2:217–21. https://doi.org/10.1046/j.1525-1403.1999.00217.x.

    Article  PubMed  CAS  Google Scholar 

  11. Sweet JA, Mitchell LS, Narouze S, Sharan AD, Falowski SM, Schwalb JM, Machado A, Rosenow JM, Petersen EA, Hayek SM, Arle JE, Pilitsis JG. Occipital nerve stimulation for the treatment of patients with medically refractory occipital neuralgia: congress of neurological surgeons systematic review and evidence-based guideline. Neurosurgery. 2015;77:332–41. https://doi.org/10.1227/NEU.0000000000000872.

    Article  PubMed  Google Scholar 

  12. Bovim G, Sand T. Cervicogenic headache, migraine without aura and tension-type headache. Diagnostic blockade of greater occipital and supra-orbital nerves. Pain. 1992;51:43–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer A. Sweet .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Staudt, M.D., Sweet, J.A. (2018). Representative Clinical Case: Occipital Neuralgia. In: Suen, J., Petersen, E. (eds) Diagnosis and Management of Head and Face Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-90999-8_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90999-8_39

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90998-1

  • Online ISBN: 978-3-319-90999-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics