occipital neuralgia

12 February 2024

Cryoneurolysis Treatment for Headache?

Cryoneurolysis is a treatment that has been used for chronic pain, but what about headache?

You may have already guessed from the prefix “cryo” that this has something to do with cold, and you’re right. In this case, it’s extreme cold – we’re not talking about ice packs.

When we use cryoneurolysis to treat pain, it’s called cryoanalgesia. There are other applications, but that’s the one that’s important to us at the moment..

Cryoneurolysis involves inserting a probe (a “cryoprobe” – no kidding) into the body to apply extreme cold to a speficic area, usually nerve tissue. The cold breaks up some of the tissue, interrupting the pain signals that are carried by the nerve. The nerve will actually regenerate over time, making this a temporary procedure – although at times the regeneration may improve your symptoms.

Now we know that for many types of headache, simply cutting off a certain pain signal from a certain nerve isn’t the answer, and may cause more problems than it solves. However, when we have a more specific understanding of where the pain is coming from, this may be a useful procedure, although it isn’t widespread yet (for headache conditions).

When you see the word “neuralgia” – a certain kind of nerve pain – that’s a clue that this type of treatment might be useful. Patients have received surgery for occipital neuralgia, for example, a certain kind of head pain from certain nerves. This 2021 study is an example of the work that’s being done for this type of condition.

Trigeminal neuralgia is another example. A study is starting in Norway to investigate the usefulness of cryoneurolysis for this very painful condition.

Cryoneurolysis has its drawbacks, which we’ve already mentioned. Its use for headache is not widespread. But it also tends to be unpredictable in its duration. How long will the pain relief be? That may vary quite a bit. And it is still a surgery.

However, researchers continue to investigate because it’s a relatively easy procedure, with few side effects. If it’s found to be useful, it can also be a very cost-effective treatment. And although the duration of relief may be unpredictable, it can last for a long time in some patients – much longer than the pills people are taking that only last a few hours at best.

For a technical overview of some of the other uses of cryoanalgesia besides headache, check out The applications of cryoneurolysis for acute and chronic pain management from 2023. For a more user-friendly summery, read Freezing Nerves, An Effective Way To Treat Chronic Pain.

13 October 2016

Nerve Pain in Head: A Different Kind of Headache

James Information, Tips 5

Sometimes it’s difficult to recognize exactly what is causing a headache. It would be nice to go to the doctor’s office and simply check off nerve pain in head on a list, and have the doctor fix the nerve. But it’s not so simple.

Nerve pain in the head is a well recognized issue. In fact, there are several types of headaches that are specifically related to nerve pain.

Nerve pain in the head They key word is “neuralgia”. And don’t get that confused with “neurotic” – it’s actually quite the opposite. Neuralgia refers to nerve pain, caused by damage or irritation to the nerve itself.

Neuralgia can occur wherever there are nerves. Typical symptoms may include sensitivity to any pressure (for example, “sensitive skin”), pain with movement, sharp stabbing pain, or pain that follows the path of the nerve. Neuralgia may even affect the muscles, causing weakness or even paralysis.

One thing to be aware of it that many patients have both neuralgia type head pain and another headache disorder. It’s important that both are recognized and treated.

Without going through all the possible diagnoses, here are some ways to recognize if you might have neuralgia head pain:

Pain is stabbing or shooting, or like an electric shock
Pain follows a certain path, and is almost always in the same place
Pain is made worse with touching or moving
Pain began at a certain time (may or may not be clearly related to a sickness or trauma/injury)

There are many possible causes in the category of nerve pain in head. It will help your doctor if you keep track of certain things. For example, do you know when the pain started? Where does it hurt (for example, back of the tongue, back of the head, jaw, etc)? What makes it worse/better? Are there other symptoms, such as eye redness, muscle weakness or contraction, sore throat, etc.?

If it seems possible that nerve damage may be involved, your doctor may call for imaging, such as an MRI, to take a closer look.

Treatment can vary drastically depending on the diagnosis (which can include Tolosa-Hunt syndrome, trigeminal neuralgia, occipital neuralgia, and many more – read about some examples of nerve pain in head). But getting the correct diagnosis early on can help you find helpful treatment as soon as possible.

4 July 2016

Stabbing Pain In Head: What’s the diagnosis?

James Information 1

You’d think that a patient complaining of stabbing pain in head would be fairly easy to diagnose. Wouldn’t there be some problem right where the stabbing occurs?

Unfortunately, it’s not that simple. There are many causes for stabbing pain in the head, but there are some good ways to narrow down the causes.

Common: An Outside Cause

If there were an obvious outside cause to the pain, such as a knife in the head, you wouldn’t be taking the time to read this article. However, the outside cause is not always completely obvious. The pain may last longer than you expect, or may spread to a part of the head that you don’t expect.

For example, cold weather, or even cold water, could cause stabbing pain. Exposure to cold may not cause an instant headache, and the headache may not go away immediately. Usually, however, it should be gone within half an hour.

Another common cause is an airplane headache. The stabbing pain is usually connected to take-off or descent. Read more about this type of headache: Are You Experiencing Airplane Headache?

It’s actually common for migraine patients in particular to be more sensitive to outside stimuli. Sometimes you’ll find the stabbing pain hitting on the same side where you commonly experience migraine pain.

Stabbing Pain in Head: Nerves/Structural Problems

Stabbing pain in head When there isn’t an outside cause, the pain may be coming directly from certain nerves.

There are various stabbing headaches that are highly related to certain nerves, such as occipital neuralgia (related to the occipital nerves, with pain in the back of the head) and classical trigeminal neuralgia (related to the trigeminal nerve, closely connected in location to parts of the nerve distribution).

In many cases certain nerves become compressed, and/or irritated. This is a common cause of stabbing pain in the head, or other parts of the body.

Irritation of nerves come from many causes – an infection or previous infection, poor posture or a previous injury. There may not even be an apparent cause.

Diagnosing Stabbing Head Pain

If there is no apparent cause, you can help your doctor to diagnose the problem by sharing the following information:

When did the pain start? Was there anything unusual happening at the time when you started to experience this pain?
Is the pain ever triggered by something specific? For example, does touching your face, or chewing, or turning your head sometimes or always trigger the pain? (In some cases, pain may be triggered at times but not at other times by the same thing. This will help your doctor rule out possible causes.)
How frequent is the pain, and how long does it last? Stabbing pain usually only lasts a few seconds, but you may have repeated “stabs”. Does it come in cycles? How long has this been happening for?
Exactly where is the pain, and does it move? This is very helpful in diagnosing nerve-related pain. Does the pain follow a path, like a streak of lightning? Is it always on the same side? Does it radiate out from a certain location? Does it come from the ear? Back of the scalp? Can you point to a specific location on your face?

If your doctor cannot find a probable cause, she may need to order a scan (such as an MRI). This will help find damage in certain locations.

Many types of stabbing head pain can be treated effectively with medication. Of course, treatment will depend very much on the type of pain you have and what your medical history is. In unusual cases when medication doesn’t work and the pain is very disabling, surgery may be an option.

Stabbing pain in the head can be difficult to diagnose, but there are good treatments available if you and your doctor can work together to get the right diagnosis.

10 July 2009

Surgery for Occipital Neuralgia

James Discoveries & Stats, Treatments 97

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.