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.