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Occipital Neuralgia Treatment

What is Occipital Neuralgia?

Occipital Neuralgia is a medical disorder that presents with piercing, throbbing, or electric-shock-like chronic pain in the upper part of the neck, back of the head and behind the ears. For some people, the pain will present in the forehead, behind the eyes, or in the scalp. Occipital Neuralgia is usually unilateral1, meaning it is only on one side of the head. The areas that are affected are directly associated with the areas innervated and supplied by the greater and lesser occipital nerves1,2.

The Occipital Nerves are the nerves that supply your brain with the information regarding sensation and pain from the back of the head2. This means that all sensation in the back of the head, neck and ears are reported to your brain via the Occipital Nerve.

Sufferers of Occipital Neuralgia are often extremely hypersensitive and report that slight stimuli such as touching the neck or the back of the head can cause painful attacks, sometimes lasting as little as seconds, or as long as minutes1. Sometimes the sensation can feel like a sharp jab or like an electric shock1. This is due to interneuronal connections between the Occipital Nerves and the Trigeminocervical neuclei1, the region of the brainstem most commonly associated with headaches and migraines. Other symptoms typically associated with Occipital Neuralgia include pain behind the eyes, vision impairment, tinnitus (ringing in the ears), dizziness, nausea and a congested nose3.

It is not uncommon for Occipital Neuralgia sufferers to go undiagnosed for long periods of time or even misdiagnosed, as the symptoms presented can be similar to those of Migraine Headaches. One key differentiating factor between Occipital Neuralgia and Migraine is the length of episodes of pain.

Anatomy of the Occipital Nerve

The Occipital Nerve is actually a group of nerves that arise from between the second and third cervical vertebrae (C2/C3) interact with each other. The Greater Occipital Nerve innervates the semispinalis capitis muscle, as well as the scalp. The Lesser Occipital Nerve innervates the scalp and behind the ears. The Third Occipital Nerve, also referred to as the Least Occipital Nerve innervates the semispinalis capitis muscle, a small area below the base of the skull, and the C2/C3 zygapophyseal joints.

What is the cause of Occipital Neuralgia?

Occipital Neuralgia has many causes, as the Occipital Nerves are one of the largest nerves supplying the head and neck. A common cause is the disruption of signals, causing the nerve to malfunction and produce pain signals when the touch sensation is activated.

Occipital Neuralgia may be the result of damage to the Occipital Nerve from surgery, brain lesions, stroke, or even from trauma inflicted to the head and neck2,3. Other nerve disorders such as Multiple Sclerosis can have a damaging effect to the Myelin Sheathing that covers the nerve and can cause Occipital Neuralgia3.

Known possible causes of irritation: vascular, neurogenic, muscular, and osteogenic3-17


  • Irritation of the C1/C2 nerve roots by an aberrant branch of the posterior inferior cerebellar artery
  • Dural arteriovenous fistula at the cervical level
  • Bleeding from a bulbocervical cavernomas
  • Cervical intramedullar cavernous hemangioma
  • Giant cell arteritis
  • Fenestrated vertebra artery pressing on C1/C2 nerve roots
  • Aberrant course of the vertebra artery


  • Schwannoma in the area of the craniocervical junction: schwannoma of occipital nerve
  • C2 myelitis
  • Multiple sclerosis


  • C1/C2 arthrosis, atlantodental sclerosis
  • Hypermobile C1 posterior arch
  • Cervical osteochondroma
  • Osteolytic lesion of the cranium
  • Exuberant callus formation after C1/C2 fracture


However, some individuals suffer from the same symptoms of Occipital Neuralgia but have no pathology or disorder that can be recognised. In these cases, the cause may be due to a sensitised brainstem.

The pain may be caused by irritation or injury to the nerves, which can be the result of trauma to the back of the head, pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumours or other types of lesions in the neck.  Localised inflammation or infection, gout, diabetes, blood vessel inflammation (vasculitis), and frequent lengthy periods of keeping the head in a downward and forward position are also associated with occipital neuralgia. In some cases, there may be no obvious signs of trauma.

A SENSITISED BRAINSTEM will perceive non-threatening stimuli (such as touching the neck) from the Occipital Nerve as a potential threat and will react, creating excruciating pain to be felt where the sensory information was originally detected. This hyper-excitability of the pain sensation is due to the heightened arousal and sensitive brainstem. A sensitive brainstem will relay the sensory information to the brain, but will heighten the sensation so that the brain perceives the information as painful.

Normal daily activities involving touching the head or neck can become “triggers” that set off painful attacks.

I’ve already tried everything. What else can be done to help Occipital Neuralgia?

Over-the-counter painkillers, strong anticonvulsant/antispasmodic medications, Botox injections and even surgery are some of the ways in which Occipital Neuralgia sufferers have attempted to rid themselves of the painful attacks. In some cases, these ways can alleviate the symptoms of Occipital Neuralgia, however despite all of these treatment options, some sufferers may still find themselves having painful attacks.

If this is the case for you, have you had your neck assessed? Or, more importantly, have you had your brainstem evaluated in order to investigate the CAUSE of your symptoms, rather than simply masking them?

At the Brisbane Headache and Migraine Clinic™, we have seen countless Occipital Neuralgia sufferers and use world-class techniques in identifying whether the neck and brainstem is at fault.

A thorough examination of the upper cervical spine is initiated to determine the severity of your SENSITISED BRAINSTEM.

Once treatment commences we expect a significant improvement to occur rapidly in 90% of our patients with Occipital Neuralgia and within the first 5 treatment consultations.

If you suffer from Occipital Neuralgia, or if you think it sounds like your symptoms and medication has given you no significant relief, then we believe that you should have a thorough examination of your neck and brainstem.

Imagine living a life free from Occipital Neuralgia and saying goodbye to medications!

To gain your recovery today contact us on 1800 HEADACHE (toll free)

1800 43 23 22

  1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia38(1), 1-211. doi: 10.1177/0333102417738202
  2. Occipital Neuralgia Information Page | National Institute of Neurological Disorders and Stroke. (2019). Retrieved from
  3. Choi, I., & Jeon, S. (2016). Neuralgias of the Head: Occipital Neuralgia. Journal Of Korean Medical Science31(4), 479. doi: 10.3346/jkms.2016.31.4.479
  4. Boes, C. (2005). C2 myelitis presenting with neuralgiform occipital pain. Neurology64(6), 1093-1094. doi: 10.1212/01.wnl.0000154470.19225.49
  5. Bruti, G., Mostardini, C., Pierallini, A., Villani, V., Modini, C., & Cerbo, R. (2007). Neurovascular Headache and Occipital Neuralgia Secondary to Bleeding of Bulbocervical Cavernoma. Cephalalgia27(9), 1074-1079. doi: 10.1111/j.1468-2982.2007.01363.x
  6. Cerrato, P., Bergui, M., Imperiale, D., Baima, C., Grasso, M., & Giraudo, M. et al. (2002). Occipital neuralgia as isolated symptom of an upper cervical cavernous angioma. Journal Of Neurology249(10), 1464-1465. doi: 10.1007/s00415-002-0845-7
  7. Garza, I. (2007). Craniocervical Junction Schwannoma Mimicking Occipital Neuralgia. Headache: The Journal Of Head And Face Pain47(8), 1204-1205. doi: 10.1111/j.1526-4610.2007.00887.x
  8. Hashiguchi, A., Mimata, C., Ichimura, H., & Kuratsu, J. (2007). Occipital Neuralgia As a Presenting Symptom of Cervicomedullary Dural Arteriovenous Fistula. Headache: The Journal Of Head And Face Pain47(7), 1095-1097. doi: 10.1111/j.1526-4610.2007.00865.x
  9. Jundt, J., of Rheumatology, D., & Mock, D. (1990). TEMPORAL ARTERITIS WITH NORMAL ERYTHROCYTE SEDIMENTATION RATES PRESENTING AS OCCIPITAL NEURALGIA. Southern Medical Journal83(Supplement), 2S-104. doi: 10.1097/00007611-199009001-00423
  10. Pfadenhauer, K., & Weber, H. (2003). Giant cell arteritis of the occipital arteries. Journal Of Neurology250(7), 844-849. doi: 10.1007/s00415-003-1104-2
  11. Rio, B., Ares-Luque, A., Tejada-Garcia, J., & Muela-Molinero, A. (2003). Occipital (Arnold) Neuralgia Secondary to Greater Occipital Nerve Schwannoma. Headache: The Journal Of Head And Face Pain43(7), 804-807. doi: 10.1046/j.1526-4610.2003.03142.x
  12. Sharma, R., Parekh, H., Prabhu, S., Gurusinghe, N., & Bertolis, G. (1993). Compression of the C-2 root by a rare anomalous ectatic vertebral artery. Journal Of Neurosurgery78(4), 669-672. doi: 10.3171/jns.1993.78.4.0669
  13. White, J., Atkinson, P., Cloft, H., & Atkinson, J. (2007). Vascular Compression as a Potential Cause of Occipital Neuralgia: A Case Report. Cephalalgia28(1), 78-82. doi: 10.1111/j.1468-2982.2007.01427.x
  14. Baer-Henney, S., Tatagiba, M., & Samii, M. (2001). Osteochondroma of the servical spine causing occipital nerve neuralgia. Case report. Neurological Research23(7), 777-779. doi: 10.1179/016164101101199171
  15. De Santi, L., Monti, L., Menci, E., Bellini, M., & Annunziata, P. (2009). Clinical-Radiologic Heterogeneity of Occipital Neuralgiform Pain as Multiple Sclerosis Relapse. Headache: The Journal Of Head And Face Pain49(2), 304-307. doi: 10.1111/j.1526-4610.2008.01209.x
  16. Postacchini, F., Giannicola, G., & Cinotti, G. (2002). Recovery of motor deficits after microdiscectomy for lumbar disc herniation. The Journal Of Bone And Joint Surgery84(7), 1040-1045. doi: 10.1302/0301-620x.84b7.12948
  17. Tancredi, A., & Caputi, F. (2004). Greater occipital neuralgia and arthrosis of C1-2 lateral joint. European Journal Of Neurology11(8), 573-574. doi: 10.1111/j.1468-1331.2004.00875.x

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