Surgery for Occipital Neuralgia

December 29th, 2012 / Back to Blog »

A large part of my practice is dedicated to the treatment of migraine headaches with microvascular nerve decompression.  In addition to decompression of numerous nerves in the forehead, temples and within the nose that cause migraine headaches, there are also nerves in the back of the head that can cause chronic headaches.

This type of headache is referred to as Occipital Neuralgia (or Arnold’s neuralgia, apparently after Dr. Arnold).  It is often confused with a chronic migraine headache, and can be equally debilitating.

Occipital neuralgia is essentially caused by trauma to either the greater or lesser occipital nerves.  This trauma can be the result of a number of things, such as:

  • A blow to the head
  • Whiplash
  • Physical stress or compression on the nerve from surrounding muscles
  • Repetitive neck flexion/extension (likely resulting in muscular compression on the nerve)
  • Compression of the nerve as it exits the spinal canal

Headaches caused by occipital nerve compression can be difficult to diagnose.  Typically, headaches begin at the base of the skull or the top of the neck and progress to the top of the head.  They can produce a shooting or stabbing pain behind the eyes or in the eyebrows, and can even progress to cause blurry vision or light sensitivity.  These pains are typically one-sided unless both left and right occipital nerves are involved.

The treatment of occipital neuralgia, as with any headache, begins with a proper diagnosis by a headache specialist (a board-certified neurologist).  Usually, the first line of treatment may involve some combination of anti-inflammatory medications (Aleve, etc), massage, and a heating pad.  After trials of these treatments,  muscle relaxants, anti-seizure medications (Tegretol or Neurontin), or anti-depressants can be used.

Steroid injections around the nerves or injections of long-acting anesthetic medications can also be used.

However, if these therapies do not work, nerve decompression surgery can be a permanent solution.  In many cases, patients with occipital neuralgia see a significant benefit with surgery.  The cure rate with surgery is high (85-95%), and those that are not cured see a substantial reduction in their symptoms.

Surgery itself involves making a small incision hidden in within the hair at the back of the neck and extensively releasing the offending nerves from the surrounding muscle and connective tissue (which often acts as the source of nerve compression).  Many patients notice an immediate change in their headaches, but full results may take months to be fully appreciated.  As with nerve decompression surgery for migraine headaches, the surgery is performed as an outpatient surgery, and no hospital stay is typically required.

If you or someone you know has migraine headaches or occipital neuralgia, call the office at 713-791-0700 and schedule a consultation to see if surgery is an option for you.