Surgery for Occipital Neuralgia

Those with occipital neuralgia have jabbing pain in the areas of the greater or lesser occipital nerves, or the third occipital nerve.  The pain, then, is usually in the lower back of the head on one side, though it can spread to other areas.  Usually there’s also tenderness over the nerve.

Often occipital neuralgia is tricky to diagnose, and it’s often misdiagnosed as migraine (or perhaps we could say that the occipital neuralgia is triggering migraine attacks?).  A full neurological exam is taken, your specialist will try to get an understanding of the pain and other symptoms (such as dizziness or photophobia), and check for tender areas.

Treatments include physical therapy, heat, medications, radiofrequency thermocoagulation (RF), stimulator implantation, and nerve blocks.

Surgery is also helpful.  A recent study out of Washington DC, USA focused on patients who had chronic migraine from occipital neuralgia.  A subset of surgery focused on the relevant occipital nerves called neurolysis was performed on 206 patients.

43.4% experienced complete headache relief, and 80.5% experienced at least 50% pain relief.  These are good numbers, especially considering that most of these patients likely have migraine that may be triggered by other causes.  There were only two patients with complications, and they were minor. (full story: Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia.)

If proper diagnosis can be done, this may be a treatment that can help a lot of "difficult to treat migraine patients".  If you’ve had this surgery, we would love to hear your comments.

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77 comments… add one

  • bryan Apr 29, 2015

    First of all I wanted to just say that it’s great to read about all of you who are going through what I am. I’ve had ON for 8 years now caused by bone spurs in my neck. After trying all manner of things my Doctor was ready to try an occiptial nerve block however my insurance cancelled the procedure the day before because it is “experimental”. I’m going back to the doc tomorrow as I think it’s now time for surgery since now all of the other options have been exausted. Has anyone had a similar experience and if so am I going to have to battle the insurance company every step of the way from here on out ?

  • Kayleen Jun 2, 2015

    Hi. I was diagnosed with chronic migraine in Feb. 2007. It was horrible – constant pain and nothing worked. I don’t know how many times I was hospitalized to have IV DHE and other infusions. I was tried on pretty much every preventative and nothing really helped – same for the abortives. In January of this year, a new headache specialist and the neuroradiologist at his hospital diagnosed me with ON. I got immediate relief from the blocks, but since they were only diagnostic, they only had lidocaine in them, no steroids. The longest that any one of them lasted was about 24 hours….but that was enough to make the diagnosis. I had my stimulator trial April 10-17. I got 90% relief of my pain! I felt better than I had in 8 years! I begged the doc not to take it out because I didn’t know how long it would be before I got the permanent. I got the permanent almost 2 weeks ago, May 21. It has been a rough recovery. I won’t lie, who I came out of the anesthesia, I was in horrible pain. My doc said that I would be “sore”. Well his idea of sore and mine are 2 different things! I was kept in the hospital overnight, which is his policy. I was alternating between morphine and percocet every 2 hours. I had a significant amount of swelling, so the stim wasn’t turned on until the day after. So far so good! Going tomorrow to get stitches and staples out. So we shall see. I only have occipital leads. My doctor doesn’t do the supraorbital ones. My surgery was done in Pittsburgh, PA.

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