How does the occipital nerve work and what irritates it?
The greater occipital nerve is formed from the root of the second cervical segment, bends around the muscles of the neck and exits under the skin in the back of the head, providing sensitivity to the back of the head to the crown. The lesser occipital nerve is responsible for the area behind the ear. On their way, nerves pass through dense muscles and fascia, where they can be compressed by spasmodic muscles. Additionally, irritation is caused by changes in the joints of the upper cervical vertebrae, the consequences of injuries and prolonged uncomfortable position of the head, for example when working on a laptop or sleeping in a chair.
- Nerve compression by spasmed neck muscles
- Changes in the joints of the upper cervical vertebrae
- Consequences of whiplash
- Prolonged forced head position
- Hypothermia and draft
- Less commonly - tumors, vascular abnormalities, infections
How it manifests itself
Typical pain is sharp, shooting, similar to an electric shock, lasts from several seconds to several minutes and is repeated in attacks. Between attacks, a dull aching pain often persists. It starts at the base of the skull on one side and rises to the crown, sometimes extending behind the ear and into the eye area. A characteristic symptom is soreness of the scalp: it is unpleasant to comb your hair, wear a hat, or lie on a pillow. An attack is provoked by turning the head, coughing, or touching a certain point at the back of the head.
- Shooting pain similar to an electric shock
- Seizures from a few seconds to minutes
- Unilateral localization in the back of the head
- Spread to the crown and behind the ear
- Scalp soreness when touched
- Provocation when turning the head and coughing
What can be confused with
Pain in the back of the head also occurs with other conditions that are treated differently. A tension headache feels like a squeezing hoop on both sides and does not have a shooting character. Migraines are often pulsating and accompanied by nausea and photophobia. In arterial hypertension, the pain is pressing and is associated with a rise in blood pressure. Particular concern is caused by sudden severe pain, a combination of pain with fever and neck stiffness, as well as neurological loss - such situations require urgent examination.
- Tension headache
- Migraine
- Cervicogenic headache
- Arterial hypertension
- Subarachnoid hemorrhage and meningitis - emergencies
- Shingles in the occipital region
Survey
The basis of the diagnosis is an examination by a neurologist: the doctor finds painful points at the exit point of the nerve, assesses the sensitivity of the scalp, the range of movements in the neck and the neurological status. X-rays of the cervical spine, including functional tests, show joint changes and instability. MRI of the cervical spine is prescribed if a disc herniation, root compression or space-occupying lesion is suspected. A diagnostic block with a local anesthetic helps confirm the diagnosis: if the pain goes away, the source is indeed in the occipital nerve.
- Neurological examination with assessment of pain points
- X-ray of the cervical spine
- MRI of the cervical spine for suspected hernia
- Diagnostic occipital nerve block
- Blood pressure measurement
- Consultation with a neurosurgeon for persistent pain
Treatment and prevention
In the acute period, the doctor prescribes non-steroidal anti-inflammatory drugs, muscle relaxants to relieve muscle spasms, and in case of severe neuropathic pain, drugs from the group of anticonvulsants or antidepressants, which are used specifically to treat nerve pain. Blockades with a local anesthetic, sometimes with the addition of a glucocorticoid, have a good effect. After the pain subsides, physical therapy for the neck, massage of the collar area and physiotherapy are included. Prevention - proper organization of the workplace, breaks, a comfortable pillow and regular exercise.
- Anti-inflammatory drugs and muscle relaxants as prescribed
- Drugs for the treatment of neuropathic pain
- Occipital nerve blocks
- Physical therapy for the neck
- Neck massage and physiotherapy
- Workplace ergonomics and comfortable pillow