Occipital neuralgia symptoms and treatment

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Neuralgia of the occipital nerve

Occipital neuralgia is called the occurrence of severe pain in the neck. The disease belongs to the category of the most uncomfortable, as it is also characterized by the presence of “shooting” pain in the head. Such neuralgia is divided into several types: primary, in which the development of the disease occurs without prerequisites, and secondary, in which case the occurrence of the disease could be facilitated by injury.

Causes of the disease

Just after hearing a diagnosis from a specialist, the patient begins to be interested in the reasons that prompted the problem. There are many of them:

  • diseases of the cervical vertebrae;
  • tonsillitis, flu, other infectious diseases;
  • spondyloarthrosis;
  • spinal injuries;
  • vertebral artery aneurysm;
  • arthritis or osteochondrosis of the cervical spine;
  • gout;
  • oncological diseases of the spinal cord and brain;
  • lymphadenitis of the glands of the neck.


Inflammation of the occipital nerve is manifested by a characteristic throbbing pain in the occipital region of the head, ears, temples, and lower jaw. It intensifies with head movements and may be accompanied by nausea. Often on the affected side there is pain in the eye area.

On palpation of the affected area, increased sensitivity is noted, and severe pain at the site of nerve projection. In this case, the patient assumes a forced position with the head tilted towards the affected nerve. The skin can acquire a reddish, or a pale shade. Lachrymation may be observed. A bilateral lesion may simulate a migraine.

Having decided to slightly delay the trip to a specialist, a person runs the risk of driving himself into a more difficult situation. The sooner competent treatment is started, the lower the risk of disturbing the innervation of the diseased nerve site!


The diagnosis of “neuralgia of the occipital nerve” is made on the basis of a survey of the patient, identification of concomitant pathology, palpation studies. As additional methods, MRI and fluoroscopy are used.


Treatment of neuralgia of the occipital nerve is aimed at relieving muscle spasm and eliminating pain impulses.

In the acute period, the patient needs rest. Strong painkillers and tablet B vitamins can cope with the pain syndrome. Anti-inflammatory drugs and muscle relaxants can be taken to relieve inflammation. Symptomatic therapy also involves the administration of anticonvulsants, if the doctor sees this as necessary.

When the pain is unbearable, anesthetics and corticosteroids are injected subcutaneously into the affected area. In this case, the pain goes away very quickly, but for a while, although under the influence of steroid drugs it no longer has such intensity.

Help in the subacute period

During the subacute period, warming procedures can be done. At home – compresses with alcohol tincture of salicylic alcohol. Acupuncture, manual therapy, massage help well.

Important points of treatment

Symptomatic therapy during treatment may not give any results if the primary cause is not eliminated. An important point in the treatment of secondary occipital neuralgia is the identification of the underlying disease and its elimination.

If there is no result from conventional treatment, it is necessary to apply surgical methods.

Surgical aid

When squeezing the occipital nerve, a method such as radiofrequency ablation is used. Its essence lies in the temperature effect on the inflamed nerve.

Electrical stimulation is another way to fight the disease. The procedure is physiotherapy, which is very important, has no contraindications. It consists in supplying electrodes with the necessary voltage to the supplied electrodes above the site of damage.

This procedure interferes with the transmission of pain impulses from nerve cells to the brain and thereby relieves pain.
After the onset of remission, it is necessary to treat the cause of the disease, since this technique is symptomatic.


In the absence of proper treatment, a disease may well lead a person to many health problems, the worst of which is blindness. In some cases, torticollis develops, which is also rarely amenable to rapid elimination.

In other words, it is always easier to get rid of the root cause than to fight the consequences of your own negligence!

Occipital neuralgia: causes, symptoms, treatment

An occipital nerve neuralgia is a disease that develops when a nerve is pinched by the tissue that surrounds it. Depending on the reasons, they distinguish:

  • primary, or idiopathic, neuralgia as an independent disease;
  • secondary, which is a symptom of another ailment.

Causes of the disease:

The main symptoms of occipital neuralgia

  • Pain arising from turning the head or touching the back of the head.
  • Pain in the eye area, above the eyes, behind the ears.
  • Unilateral spread of pain, extremely rarely – bilateral.
  • “Shooting pain” in the neck.
  • Painful sensations in the eyes when exposed to bright light.
  • Headaches, fatigue and irritability.
  • Sleep disturbance, sometimes – disorientation, dizziness, nausea.

Treatment of neuralgia of the occipital nerve

There are two types of treatment for this disease:

Conservative treatment involves:

  • peace and relaxation;
  • heat treatment of the affected area;
  • massotherapy;
  • the use of muscle relaxants, the use of drugs against seizures.

Surgical intervention for neuralgia of the occipital nerve is of two types:

  • microvascular decompression, which frees the nerve from compression;
  • stimulation by electric pulses aimed at blocking the pain syndrome.

The prognosis for recovery is often favorable. In order for the treatment process to be as short and effective as possible, you should contact your doctor when the first symptoms appear and do not self-medicate.

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Neurologist of the first qualification category.
Education: internship in neurology (2004); Siberian State Medical University, specialty – medical business (2003).
Further education courses: Neurology, Siberian State Medical University (2008); Neurology, IPM FMBA (2013); Examination of temporary disability (EVN) and the quality of medical care, RMAPO (2013); Manual therapy, RNIMU them. N.I. Pirogov (2014); Kinezio Tapping Advanced Certificate (KT1-KT2) (2015); Principles of osteopathic diagnosis and correction of somatic dysfunctions of limbs, cranial bones, Institute of Osteopathy (2015); Principles of osteopathic diagnosis and correction of somatic dysfunctions of the spine and pelvis. Introduction to the craniosacral section of manual medicine, osteopathy, Institute of Osteopathy (2015); General principles of manual medicine, osteopathy. Introduction to the structural section of manual medicine, osteopathy, Institute of Osteopathy (2015); Manual therapy, St. Petersburg State University (2016); Kinezio Tapping Advanced (KT3-KT4 Sport) Kinesiotherapy Certificate (2016).
Full member of the Russian Osteopathic Association.
Medical experience – 14 years.

Neuralgia treatmentspecified at the reception

Education: internship in neurology on the basis of the Voronezh OKB No. 1 (2004); Voronezh State Medical Academy named after N.N. Burdenko (2003).
Professional retraining in manual therapy (2012).
Certificate: “Neurology”, Medical Institute of Continuing Education “MGUPP” (2019).
Further training: “Deep reflexo-muscle massage” (1997); “Medical Massage”, Voronezh State Medical Academy named after N.N. Burdenko (2003); “Occupational pathology”, RNIMU them. N.I. Pirogov (2006).
Medical experience – more than 15 years.

Neuralgia treatmentspecified at the reception

A doctor of the highest qualification category.
Education: First MGMU named after THEM. Sechenov, specialty – medical business (2010).
Certificates: Functional diagnostics, RNIMU them. N.I. Pirogov (2015); Neurology, UMTS UD President of the Russian Federation (2012).
Medical experience – 7 years.

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Neuralgia treatmentspecified at the reception

He has experience in the differential diagnosis of diseases manifested by episodes of short-term loss of consciousness, using the results of an electroencephalographic study. He prescribes complex therapy for encephalopathies of various origins, vascular diseases of the central nervous system, and for lesions of the trigeminal, facial and occipital nerves, and provides counseling for psycho-emotional disorders and depressive states. He knows the techniques of acupressure, acupuncture and medical blockade.
A doctor of the highest qualification category.
Education: internship, specialty – psychiatry (1991); Tashkent Medical Institute, specialty – medical business (1984).
Refresher courses: EEG, TashIUV (1992); Neurology, TashIUV (1993); Neurology, IRT Su-jok, Korean Medical Institute (1995); Neurology, Research Institute of Neurology. THEM. Sechenov, City Clinical Hospital №50, City Clinical Hospital named after S.P. Botkin (2006, 2008, 2013).
Medical experience – 32 years.


Neuralgia treatmentspecified at the reception

A doctor of the highest qualification category.
Education: internship in neurology at the OKB. I.I. Mechnikov, Dnepropetrovsk, Department of Neurology and Neurosurgery (1992); Dnepropetrovsk Medical Institute, specialty – medical business (1991).
Certificate: Neurology, Department of Neurology, Gerontology and Geriatrics, Faculty of Continuing Education of Medical Workers of RUDN University (2014).
Medical experience – more than 25 years.

Neuralgia treatmentspecified at the reception

A doctor of the highest qualification category.
Education: residency, specialty – children’s neurology, Kazan State Medical University (1983); internship, specialty – pediatrics, Chuvash State Medical University. I.N. Ulyanov (1977); Gorky Medical Institute, specialty – pediatrics (1976).
Certificate: Neurology, RMAPO (2014).
Further education courses: Modern methods for the diagnosis and treatment of central nervous system diseases in children (1999); Depression in children, RMAPO (2003); Pediatric Neurology, RMAPO (2008).
Member of the Moscow Society of Pediatric Neurologists.
Medical experience – 41 years.

Neuralgia treatmentspecified at the reception

Education: internship in neurology, Nizhny Novgorod State Medical Academy (2008); Mordovian State University N.P. Ogareva, specialty – medical business (2007).
Certificates: “Neurology”, RMAPO (2014); “Functional diagnostics”, TsGMA UD of the President of the Russian Federation (2016).
Further training: “Fundamentals of the modern management of aging diseases”, State Research Center for Advanced Medical Research (2015); “From the neuron to the brain. Recovery of lost or changed functions ”(2015); “Actual issues of neurology” (2016); “Fundamentals of Modern Electromyography,” Training Center for Continuing Medical and Pharmaceutical Education (2017).
Member of the Interdisciplinary Medicine Association.
Medical experience – more than 10 years.

Neuralgia treatmentspecified at the reception

For more than fifteen years, the doctor worked in large Moscow municipal multidisciplinary hospitals, which allowed to accumulate extensive experience in the differential diagnosis of neurological diseases and functional disorders, as well as providing assistance in acute cerebrovascular disorders. He knows the technique of all types of therapeutic blockades. Advises adolescent patients who have come up for neurotic and emotional disorders, draw up rehabilitation programs after neuroinfections and brain injuries.
The doctor of the first qualification category (2010).
Education: residency, specialty – neurology, RSMU (2001); clinical internship, specialty – neurology and neurosurgery (1999); Moscow Medical Dental Institute ON THE. Semashko, specialty – medical business (1998).
Refresher courses: Vertebroneurology with the basics of manual therapy (2000); Reflexotherapy (2001); Neurology (2005, 2010); Thermal and ultrasound diagnostic methods in emergency and planned neurology (2006); Diagnosis and therapy of depressive and anxiety disorders in general medical practice, RUDN University (2015); Diagnostic and treatment options for depressive and anxiety disorders in general medical practice, RUDN University (2015); Discirculatory encephalopathy-modern diagnostic algorithms and complex therapy. Clinical analysis (2016).
Certificate for the basic course of SU JOK acupuncture at the Academy SU JOK (1998).
Lecture course at the Vertigo School of Integro (2014).
He takes an active part in the educational seminars School of Health; The principles of treatment in neurology and psychiatry of depression, dizziness, panic disorder.
Medical experience – 19 years.

What is occipital neuralgia

Pain in the head region resulting from compression of the nerve roots or the occipital nerves themselves is called neuralgia. The pain often has a shooting character, and with the progression of the disease become permanent. The pathology of the peripheral nervous system does not threaten a person’s life, however, it can significantly degrade its quality.

Occipital neuralgia is a symptom complex that indicates damage to the nerve fibers of the cervical plexus. In most cases, the large occipital nerve is involved in the pathological process (the large ear and small occipital nerves may also be affected).

Usually, neuralgia develops with irritation of nerve roots located in the back of the head. It is divided into 2 types:

  • primary (occurs without obvious prerequisites);
  • secondary (occurs against the background of injuries, neoplasms, etc.).

The causes of neuralgia of the occipital nerve may be:

  • injuries of the cervical spine;
  • infectious processes;
  • muscle tension of the cervical spine due to a static position;
  • diseases of the spine;
  • osteochondrosis;
  • connective tissue diseases;
  • inflammatory processes in the vessels;
  • gout;
  • diabetes.

In older people, the disease can develop due to various metabolic disorders.

Among the possible complications of neuralgia of the occipital nerve, there are:

  • persistent drug-dependent headache;
  • wryneck;
  • blindness
  • concomitant mental disorders associated with constantly experiencing pain.

Symptoms of cervical neuralgia

The main symptom of pathology is a headache. With occipital neuralgia, it has a specific character:

  • pain is concentrated behind the ears, in the back of the head, in the lower part of the neck, in the eye area;
  • pain attacks occur suddenly, usually after turning the head or touching the zone of innervation of the occipital nerve;
  • soreness is often localized on the one hand, bilateral lesion is less common;
  • the pain is shooting in nature, appears sharply and suddenly disappears;
  • bright light invokes pain in the eyes.

In addition to pain, among the symptoms of neuralgia of the head, there are:

  • violation of sensitivity in the neck;
  • forced position of the head;
  • pallor of the skin;
  • sensation of “goosebumps”;
  • feeling of cold;
  • increased pain when coughing, sneezing, turning the head.

Diagnosis of inflammation of the occipital nerve

The clinical manifestations of the disease are similar to migraines and a number of other neurological pathologies. Identify the disease help:

  • radiography;
  • CT scan;
  • Magnetic resonance imaging.

Features of the treatment of cervical neuralgia

Drug therapy is based on the use of drugs that relieve the patient of unpleasant symptoms. For this purpose, patients are prescribed painkillers. Muscle relaxants are prescribed to eliminate muscle spasms.

Also, patients are prescribed anticonvulsants, steroidal anti-inflammatory drugs, sedatives, and B vitamins. In the case of extremely severe pain in case of inflammation of the occipital nerve, novocaine blockades can be used.

Physiotherapy helps to achieve good results:

  • physiotherapy;
  • acupuncture;
  • special massage;
  • spinal traction;
  • ultrasound therapy;
  • magnetotherapy;
  • electrophoresis;
  • laser therapy.

In the treatment of neuralgia of the head, physiotherapy is combined with medication. This allows you to quickly get rid of pain and neurological manifestations.

In addition to stopping symptoms, it is important to pay attention to the root cause of neuralgia and eliminate it.

If the pain persists for a long time, has a pronounced character and conservative treatment of neuralgia of the occipital nerve does not bring results, they can resort to radical measures. For this purpose apply:

  • stimulation of the occipital nerves in the projection of the nerve exit (electric current is used);
  • pulsed radiofrequency ablation of the occipital nerves;
  • microvascular decompression (a microsurgical technique for eliminating nerve compression).

How to prevent occipital neuralgia?

In order to prevent, it is recommended to avoid physical inactivity, provide a sufficient amount of physical activity. Try to protect the cervical spine from injury. Avoid hypothermia in the neck.

If professional activity is associated with long sedentary work, it is important to regularly take breaks and perform exercises to warm up the cervical spine. It is also necessary to eat properly to supply the body with all the necessary vitamins and minerals.

How to cure an occipital nerve neuralgia

Occipital neuralgia is a pathological condition of the peripheral part of the nervous system. It is easy to diagnose it, but it is much more difficult to determine the real cause, and the disease can be eliminated only with the help of drugs or through surgery.

Lesion area

A distinctive symptom of occipital nerve neuralgia (NZN) is a severe headache in the back of the head, which is specific in nature. This is due to the fact that the fibers of the occipital nerve are compressed and irritated.

In total, a person has 4 occipital nerves: one large and one small on the left and right sides of the head. The main purpose of the large is the transmission of sensitive impulses, the innervation of the skin. It does not affect muscle function.

This also applies to the small occipital nerve, which innervates the area of ​​the skin located behind the ear. But its fibers pass through other areas, therefore, knowledge of the topography (location) of nerve endings allows you to accurately determine the lesion site during the diagnosis process.

All fibers of the occipital nerves emanate from the vertebral canals located between the 2nd, 3rd and 4th vertebrae of the neck, so any trauma to this area can lead to SCD.


NZN can act as an independent disease, but more often it is a consequence of other pathologies. This is what became the basis for the allocation of two varieties of neuralgia of the occipital nerve:

  1. Primary or idiopathic. Also called Arnold Neuralgia. Its occurrence is defined as spontaneous, unconditioned by other factors.
  2. Secondary or symptomatic. It is a consequence of one of a number of diseases:
    • osteochondrosis;
    • osteoarthritis;
    • pathologies of the intervertebral discs;
    • infectious diseases (lupus erythematosus, spinal tuberculosis);
    • prolonged low-temperature exposure to the head;
    • cramps of the cervical muscles, provoked by overload and leading to secondary infringement of the roots formed by the occipital nerves;
    • anomalies of the craniovertebral junction;
    • diabetes mellitus;
    • gout;
    • rheumatoid arthritis;
    • injuries of the spine and tumors in the neck and neck.

Regardless of the source of the pain, seeking medical attention is a must. In the case of secondary inflammation of the occipital nerve, you can get rid of a headache when a specialist cures an underlying disease that can be a serious life threat (for example, if it is a tumor).


In the case of NZN, pain is felt in the back of the head and radiates to the ear and neck. It is paroxysmal in nature. Usually it is one-sided, but with extensive damage it will be felt on both sides. Pain can also be felt in the eye area and above them, sensitivity to bright light increases.

According to the description of patients, pain with occipital neuralgia feels like burning and pulsating, reminiscent of a current discharge. The acute and severe pain “shoots” exactly where the nerve fibers pass. Another attack can be triggered by coughing, sneezing and sudden movements, as well as a simple touch and combing.

But often the pain occurs completely spontaneously and lasts no longer than a few minutes, although the number of seizures during the day can be more than a hundred, and between them there is a slurred interictal pain syndrome. Such manifestations lead to the fact that a person becomes disabled, but the discomfort subsides if the head is tilted a little back and sideways.

Along with this, burning and tingling sensation, the sensation of running flies, and the skin in the affected area become very pale or, on the contrary, turn red. Also often occurs:

  • dizziness;
  • nausea;
  • vomiting;
  • discomfort when touching the affected area;
  • causeless lacrimation;
  • persistent feeling of cold.

Symptoms of cervical neuralgia arising from pinching (and not irritation) of the occipital nerve include:

  • severe pain, covering the area between the back of the head and shoulders;
  • headaches resembling migraine attacks;
  • loss of sensation;
  • muscle atrophy and numbness.

In the presence of such manifestations, you should immediately consult a doctor and begin treatment.

Trigger points

One of the typical signs of occipital neuralgia is special trigger (starting) points. The impact on them responds with pain. In the small occipital nerve, such areas are located at the junction of the mastoid process with the posterior edge of the sternocleidomastoid muscle.

And if the conditional line between the occipital tubercle and the mastoid process is divided into 3 segments of equal length, then you can find the starting sections of the large occipital nerve. Before treatment, it is better not to touch them, so as not to provoke an additional attack of pain.


The diagnosis is made already at the initial examination. However, to identify the exact causes of the disease, the doctor may prescribe:

  • radiography of the spinal column;
  • MRI or CT scan of the cervical spine.

If these types of studies do not reveal the presence of any pathologies, then neuralgia will be classified as primary, which means that it will only need to be treated. With symptomatic NZN, therapeutic actions will be aimed at eliminating not only the neuralgia itself, but also the disease that provoked it.


The treatment of neuralgia of the occipital nerve is carried out in several ways. Among them:

  1. Conservative:
    ◦ use of medicines:
    ▪ NSAIDs (Naproxen, Meloxicam, Diclofenac, Ibuprofen);
    ▪ drugs that relax muscles and relieve spasms (Midokalm, Sirdalud);
    ▪ anticonvulsants (Pregabalin, Carbamazepine);
    ▪ drugs for the treatment of depression (amitriptyline).
    ◦ blockade of transmission of a nerve impulse – injection:
    ▪ hormonal substances (Hydrocortisone, Dexamethasone, Diprospan, Kenalog);
    ▪ anesthetics (Novocain, Lidocaine).
    ◦ physiotherapy;
    ◦ massage;
    ◦ exercise therapy;
    ◦ spinal traction and manual therapy.
  2. Surgical:
    ◦ microvascular decompression (used to relieve nerve fibers from compression);
    ◦ neurostimulation (allows you to suppress pain impulses by electrical).

If the operation cannot be dispensed with, then the case is probably neglected. It should be noted that the second type of surgical intervention is carried out under the control of the patient. The specialist prescribes to the patient only taking medications and undergoing medical procedures.

Folk remedies

Occipital neuralgia can be treated not only with pills, massage or surgical methods. At home, it is quite possible to try to alleviate the condition of an adult or a child with the help of folk remedies:

  1. Ointment from the lilac buds. To prepare it, you need a thick broth of lilac mixed with pork fat. After cooling, this product is used to rub into the inflamed areas of the head and neck.
  2. Infusion of dream grass. Dry raw materials (2 tbsp. L.) Pour boiling water (0,2 l) and let it brew for a day. At the end of the specified period, the product is ready for use. You need to use it within one day. This infusion is effective not only in the fight against neuralgia, it can be useful in migraines, neurasthenia and insomnia.
  3. Decoction of willow bark. Dried bark (10 g) pour boiling water (0,25 l). Put the container with the future broth on a slow fire and boil for 20 minutes. Next, you need to wait until the liqu >


Due to the lack of necessary treatment, the inflammatory process observed with neuralgia leads to unpleasant consequences in the form of neuropathy (neuritis). In this case, the structure of the nerve sheath changes, which provokes the continuous transmission of nerve impulses.

The pain becomes chronic. It is possible to cure the disease (more precisely, to get rid of its root cause), and it will be impossible to stop the pain syndrome without neurosurgical surgery.


To ensure the prevention of neuralgia of the occipital nerve, it is necessary:

  • rationally organize your workflow;
  • Exercise regularly
  • try to avoid hypothermia and injury;
  • make the diet more healthy, ensure the supply of a sufficient amount of vitamins;
  • to maintain the correct position of the neck during work;
  • timely treat flu and other similar diseases;
  • regularly go to physiotherapy sessions;
  • properly distribute physical activity.

In addition, the treatment of respiratory diseases of a viral origin should be taken in a timely manner, since the occipital nerves can also become inflamed because of them.

This pathology of the occipital nerve cannot be ignored. You need to contact a specialist at the first suspicion of its presence. A neurologist will help not only identify the real cause of nerve inflammation, but also determine for the patient the most suitable therapeutic course, which (with timely treatment) will help to achieve a complete cure.

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.