Neuralgia of the occipital nerve: symptoms and treatment

Neuralgia of the occipital nerve is one of the types of headache. It is associated with irritation and compression of the fibers of the occipital nerve, characterized by specific characteristics of the pain itself. Neuralgia of the occipital nerve can be an independent disease, but more often due to the presence of other health problems that provoke its development. In any case, this condition requires medical intervention, since it substantially poisons a person's life. This article will provide information on the causes, symptoms, diagnosis and treatment of neuralgia of the occipital nerve.

There are four occipital nerves in a man: two large and two small (one on each side, respectively). Large occipital nerves are formed from the posterior branches of the 2nd cervical spinal nerve (CII). Fibers of the nerve pass around the lower edge of the lower oblique muscle of the head, perforate the semimineral muscle and the tendon of the trapezius muscle at the place its attachment to the occipital bone, and then disintegrate into several branches in the skin of the occipital and partially parietal region. Thus, the large occipital nerve is a sensitive nerve that provides innervation of the skin. It has nothing to do with innervation of muscles, because it passes through them in transit, without giving up branches.

The small occipital nerve is formed from the anterior branches of the 2nd and 3rd spinal nerves (CII and CIII), being the nerve of the cervical plexus. The nerve is also sensitive, it exits behind the sternocleidomastoid muscle at the site of its attachment to the mastoid process. The nerve provides innervation of the skin of the posterior-lateral part of the head (behind the ear). Irritation or compression of the nerve at any part of its course causes neuralgia of the occipital nerve.

The anatomical data of the occipital nerves are important for the diagnosis of neuralgia of the occipital nerve. Knowing the course of the fibers allows you to determine the trigger points, the pressure on which causes typical symptoms of the occipital nerve and confirms the diagnosis. But we'll talk about this a little later. Now let's get acquainted with the causes of neuralgia of the occipital nerve.

Causes

There are two forms of neuralgia of the occipital nerve:

• idiopathic (primary), which is still called Arnold's neuralgia;
• symptomatic (secondary).

Neuralgia Arnold has no known cause for the scientist, that is, one can say that it arises spontaneously, in the absence of other causes.

Symptomatic neuralgia of the occipital nerve is the result of other diseases. In this case, it can be a manifestation:

• degenerative-dystrophic processes in the cervical spine (osteochondrosis, spondylosis, spondylarthrosis, protrusion or herniation of intervertebral discs);
• trauma of the cervical spine;
• abnormalities of the craniovertebral junction;
• tumor process of cervical spine, occipital region;
• prolonged overload of the neck muscles, which is accompanied by the development of spasm (the preservation of a certain posture, for example, bending over a computer or a sewing machine during the working day);
• hypothermia of the head (absence of a headdress in the cold season);
• a number of somatic and infectious diseases (diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, spinal tuberculosis, gout, endarteritis, viral infections of the body).

Symptomatic neuralgia of the occipital nerve does not disappear without treatment of the underlying disease. Sometimes its manifestations are the first sign of another disease. It is necessary to find out the true cause of neuralgia of the occipital nerve in order not to miss a more formidable disease (for example, a tumor).

Symptoms

With occipital neuralgia, a painful attack begins in the nape of the neck and gives to the neck, ear.

Since the occipital nerves are sensitive nerves, the main manifestations of the disease lie in the sphere of sensations.

The most important symptom of neuralgia of the occipital nerve is paroxysmal pain. Pain occurs in the zone of innervation of the occipital nerves, that is, mainly in the occiput. Pain gives in the neck, in the ear. It can be one-sided (which occurs much more often) or bilateral, depending on the extent of occipital nerve entrapment.

The nature of pain is peculiar. Patients describe their feelings, like lumbago, the passage of an electrical discharge, a searing pulsation. The feeling spreads clearly along the nerve fibers following. The pains are sharp, quite strong in intensity (even painful), provoked by movements (turns) of the head, sneezing, coughing, although they themselves arise spontaneously. In order not to provoke pain, patients give the head a forced position, slightly tilting it back and sideways.

The duration of one attack of pain from a few seconds to several minutes. The number of bouts of pain during the day is very variable: from individual to tens and hundreds. Of course, a large number of seizures is much more difficult for the patient, prevents a habitual way of life, and causes disability.

In a number of cases, during the interictal period, dull, aching pain persists in the occipital region.

A characteristic feature of the disease is the presence of specific trigger points, pressure on which causes an attack of pain. These are the following points:

• for the great occipital nerve - it is conventionally necessary to draw a line connecting the mastoid process and the occiput, dividing it into three equal parts. The point is located between the middle and inner third;
• for the small occipital nerve - in the area of ​​attachment of the sternocleidomastoid muscle to the mastoid process, along its posterior margin (Kerer point).

Another symptom of neuralgia of the occipital nerve may be a decrease in sensitivity in the innervated area: the prick is felt as a touch, and a slight touch is not generally perceived by the patient. In the occipital region there may be paresthesia: unpleasant sensations of tingling, crawling, chills, and similar sensations. Skin in this area can change color: it becomes either pale or red.

Diagnostics

The diagnosis of neuralgia of the occipital nerve usually presents no difficulties. This is the diagnosis that is exhibited at the first examination by a doctor. Typical complaints, as well as the emergence of pain when pressing the trigger points leave no doubt. However, the cause of the disease remains unexplained. To find the primary source designate additional research methods:

• roentgenography of the cervical spine;
• computer or magnetic resonance imaging of the cervical spine.

In the absence of pathological changes in the course of the studies, neuralgia of the occipital nerve is considered primary. This plays a role in the treatment of the disease. With symptomatic neuralgia of the occipital nerve, along with therapeutic measures aimed at its elimination, simultaneously treat the disease that caused neuralgia.

Treatment

Treatment of neuralgia of the occipital nerve can be conservative and operative. First of all, they try to cope without surgery.

The conservative methods of treatment include:

• use of non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Meloxicam, Naproxen and others). The drugs have an analgesic, anti-inflammatory effect;
• the use of muscle relaxants, that is, drugs that reduce muscle tone. This is justified in cases where the development of the neuralgia of the occipital nerve is due to spasm of muscles on the path of the nerve. The most effective among this group of drugs are Tizanidine (Sirdalud) and Midokalm;
• the use of anticonvulsants (Carbamazepine, Gabapentin, Pregabalin) and antidepressants (Amitriptyline, Duloxetine). Similar actions are taken in cases of persistently not stopping pain syndrome;
• blockade of the occipital nerve. This manipulation is an introduction to the point of exit of the nerve onto the skin of a mixture of medicinal substances. It can be hormones (Hydrocortisone, Diprospan, Dexamethasone), or anesthetics (Lidocaine, Novocain), or a mixture of these. If the blockade is performed correctly, the pain syndrome is eliminated. Sometimes, after a while, a blockade is required;
• methods of physiotherapy (ultrasound, laser therapy, electrophoresis, magnetotherapy);
• massage, complexes of physiotherapy exercises;
• acupuncture;
• manual therapy and spinal traction (suitable for degenerative-dystrophic processes in the cervical spine).

If conservative methods of treatment failed to get rid of neuralgia of the occipital nerve, then resort to surgical treatment. Surgical intervention can be of two types:

• microvascular decompression. This type of surgical treatment is used in cases where the occipital nerve is squeezed by a number of located structures (in particular, pathologically altered vessels);
• Neurostimulation. Under the skin in the neck region, a special device that generates electrical impulses is implanted. Impulses suppress painful stimuli. The patient himself can regulate the activity of the neurostimulator.

And yet, in most cases, it is possible to cope with neuralgia of the occipital nerve without the involvement of surgeons.

Thus, summing up the above, it should be said that the neuralgia of the occipital nerve is a pathology The peripheral nervous system, the main manifestation of which is a headache in the nape. The disease does not pose a threat to a person, but a significant pain syndrome becomes a spoonful of tar in a barrel of honey against a background of normal health. Neuralgia of the occipital nerve is easily diagnosed, but always requires a search for the true cause of its occurrence. To get rid of the disease can be conservative or surgical methods. The main thing is not to delay the visit to the doctor.

Doctor-neurologist of the clinic Siena-Med Bukhtoyarov S. N. tells about what is the neuralgia of the occipital nerve, what are its symptoms, the principles of diagnosis and treatment:

Treatment of neuralgia of the occipital nerve. Clinic and diagnosis of occipital neuralgia.

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