One cause of chronic headaches that is often overlooked is occipital neuralgia. Occipital neuralgia is a type of headache that generally begins in the neck and then spreads up through the back of the head, causing throbbing, piercing pain. Often the scalp becomes tender, and sufferers may experience pain behind the eyes and become sensitive to light. Many people describe the pain as migraine-like, and the acute symptoms of occipital neuralgia can be at least as severe as those caused by migraine.
Occipital neuralgia is caused by injury or irritation to the occipital nerves, which travel up from where the spine connects with the neck to the back of the head. Trauma to the back of the head or nerves compressed by swollen or tight neck muscles are the most common causes of this type of headache. Pressure on the occipital nerves can result in a worsening of symptoms, and physical tension often triggers an attack.
Diagnosis of occipital neuralgia can be difficult, and is usually made based on clinical presentation alone. Often, pressing directly on the area over the nerve will cause pain, and this reaction is generally used as a first step in making a diagnosis. Some doctors will attempt to diagnose the condition by injecting a local anaesthetic into the area of the occipital nerve. Relief from pain after this procedure is very indicative of occipital neuralgia.
Other conditions that may cause or worsen occipital neuralgia include osteoarthritis of the upper cervical spine, cervical disc disease, tumors, diabetes, gout, inflammation of the blood vessels, and various infections. When a cause can be identified, treatment is aimed at the underlying condition. For most patients, no underlying disorder is found, and treatment is mainly symptomatic.
Treatment most often includes a combination of rest, heat, physical therapy, and anti-inflammatory medications. If those treatment options fail, local nerve blocks can be injected into the area of the occipital nerve and may provide pain relief for many people. For those dealing with chronic and severe pain, surgical intervention is a possibility, but is usually regarded as a last resort.
The headaches and inflammation of the muscles in the neck caused by chronic occipital neuralgia can be disabling if left untreated. Occipital neuralgia, especially when secondary to another condition, may eventually resolve on its own. The majority of the time, however, it is a lifelong condition requiring treatment by a neurologist and long-term use of pain and anti-inflammatory medications.