Occipital neuralgia

Occipital neuralgia

Occipital neuralgia, also known as C2 neuralgia, or (rarely) Arnold’s neuralgia, is a medical condition characterized by chronic pain in the upper neck, back of the head and behind the eyes. These areas correspond to the locations of the lesser and greater occipital nerves. The greater occipital nerve also has an artery that supplies blood that is wrapped around it – the occipital artery – that can contribute to the neuralgia. This condition is also sometimes characterized by diminished sensation in the affected area as well.

Etiology

Occipital neuralgia typically arises in the setting of nerve compression by fibrosis, surrounding anatomic structures, or osseous pathologies, such as bone spurs or hypertrophic atlanto-epistropic ligament. It generally presents as paroxysmal bouts of sharp pain in the sensory distribution of the first three occipital nerves. Due to the long course of the greater occipital nerve (GON), and its peculiar anatomy, and location in a mobile region of the neck, it is unsurprising that the GON is at high risk for compression.

Keep in mind that conditions such as occipital neuralgia may occasionally follow whiplash-type injuries and should be treated appropriately.

Odontoid fracture.

Almost all conscious patients with Hangman’s fracture will have cervical pain usually in the upper posterior cervical region, and occipital neuralgia is not uncommon.

C1 lateral mass screws.

After Microvascular Decompression.


Little is known how to diagnose or treat this neuropathic pain syndrome.

After all nonoperative efforts are exhausted, surgical transection of the nerve is the treatment of choice in these cases. An isolated C2 neurectomy or ganglionectomy is performed for optimal pain relief. C1-2 instrumented fusion can be considered if, extensive facet arthropathy with instability is identified 1).

Treatment

1)

Janjua MB, Reddy S, El Ahmadieh TY, Ban VS, Ozturk AK, Hwang SW, Samdani AF, Passias PG, Welch WC, Arlet V. Occipital neuralgia: A neurosurgical perspective. J Clin Neurosci. 2019 Oct 9. pii: S0967-5868(19)31411-0. doi: 10.1016/j.jocn.2019.08.102. [Epub ahead of print] Review. PubMed PMID: 31606286.

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