What is this severe pain coming from the back of the head? (Occipital Neuralgia)

Have you ever had a sharp, stabbing pain in the back of your head, starting at the point where your neck and head meet, traveling up your skull, and sometimes ending behind your eyes, like a jolt of electricity? It may go away in a few seconds, but it can sometimes last for hours. This is not a normal headache. In medical terms, we call this Occipital Neuralgia .

Simply put, what is Occipital Neuralgia?

Okay, let's break this down. There are two main nerves that start at the top of your spine and run up through your neck and up the back of your head and up your skull. These are what we call the 'Occipital Nerves.' These nerves carry sensations from the back and top of your skull to your brain.

Now imagine, what happens if these nerves get compressed or inflamed for some reason? Just like when you squeeze a water pipe, water spurts out, when these nerves get compressed, they send abnormal pain signals to the brain. That unbearable, sharp pain is what we call Occipital Neuralgia .

What are the symptoms of this condition?

The main symptom of occipital neuralgia is pain. But this is not like a regular headache. The way this pain comes on is very different.

• The pain often starts at the back of the head, near the neck.
• From there, it can spread upward along the scalp to one side or both sides .
• Some people can even feel pain behind their eyes .
• Your scalp may feel very sensitive when you touch it or even comb your hair.

The nature of this pain can vary. See the table below.

Why do we have this situation?

Most of the time, the main cause of this is the compression of the occipital nerve we talked about due to tight neck muscles . This condition can also occur after a sudden accident to the head or neck.

In addition, this risk is slightly higher for people with certain medical conditions.

• Degenerative disk disease (spinal disc disease)
• Diabetes
• Gout
• Osteoarthritis of your upper spine
• Inflammatory conditions in the blood vessels (Vasculitis)

How does a doctor accurately diagnose whether this is occipital neuralgia?

This can be a bit tricky to diagnose because the symptoms are very similar to migraines and other types of headaches. So your doctor will often refer you to a neurologist .

The doctor will ask you a detailed question about your pain and examine you. Then, if necessary, they may refer you for tests such as:

• CT scan or MRI scan: These can clearly see the inside of your spine and neck.
• Occipital nerve block: This is the best way to confirm this condition. Simply put, a small amount of anesthetic is injected into the area where the painful nerve is located. If the pain disappears, it can be confirmed that the problem is in that nerve.

What are the treatments for this?

The good news is that there are very good treatments for this. The main goal of treatment is to reduce your pain.

Non-surgical treatments

Many people get good results with these simple treatments.

• Hot frying:Applying a hot water bottle to the back of the neck can help relax the muscles and reduce pain.
• Massage therapy: Having an experienced person gently massage the tight muscles in your neck can help reduce nerve compression.
• Physical therapy: Special exercises performed under the guidance of a physical therapist can strengthen the neck muscles and prevent the pain from recurring.
• Nerve blocks: These injections are used for both diagnosis and treatment. They are administered along with an anesthetic and a steroid to reduce swelling and pain in the nerve.
• Botulinum toxin (Botox®) injections: These can also relax muscles and reduce swelling in the nerve.

Medicines prescribed by the doctor

Depending on your condition, your doctor may prescribe medications such as:

• Anticonvulsants: These control the hyperactivity of the nerves and reduce pain.
• Muscle relaxants: Help reduce stiffness in the neck muscles.
• Painkillers (Nonsteroidal anti-inflammatory drugs - NSAIDs): These are given to control pain and swelling.

Surgery

Surgery is rarely resorted to, only if the above treatments fail.

• Occipital nerve stimulation: Small electrodes are placed near the nerve, stopping pain signals from reaching the brain.
• Spinal cord stimulation: Electrodes are also placed near the spinal cord to block pain signals.

At what point do you need to go to the ETU (Emergency Treatment Unit) in an emergency?

Although the pain of occipital neuralgia can be severe, it is usually not an emergency. However, if you have any of the symptoms below along with your head or neck pain, it could be a sign of something serious. In such a case, go to a hospital's Emergency Department (ETU) immediately.