Occipital Neuralgia

Current Pain and Headache Reports - Tập 25 - Trang 1-7 - 2021
Wenyu Pan1, Joanna Peng1, Dalia Elmofty1
1Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, USA

Tóm tắt

Occipital neuralgia is a painful condition that affects the posterior aspect of the head and can be difficult to distinguish from other common forms of headaches. This article reviews the anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for occipital neuralgia. Non-pharmacological treatments aim to alleviate muscle tension and improve posture. Acupuncture shows some promise. The occipital nerve block is considered the first line in a minimally invasive intervention, but the duration of relief may be short term. An onabotulinum toxin A injection may improve the sharp but not the dull component of the pain of occipital neuralgia. Radiofrequency ablation and occipital nerve stimulation may provide effective long-term relief in refractory patients. Surgical decompression, neurotomies, and neurolysis are last-resort treatment options. Occipital neuralgia is a debilitating condition that can be difficult to treat. Studies with larger sample sizes and randomized control trials are needed to further determine the effectiveness and safety of different therapies.

Tài liệu tham khảo

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1):1-211.

Vanelderen P, Lataster A, Levy R, Mekhail N, van Kleef M, Zundert V. Occipital neuralgia. Pain Pract. 2010;10:137–44.

Barmherzig R, Kingston W. Occipital neuralgia and cervicogenic headache: diagnosis and management. Current neurology and neuroscience reports. 2019;19(5):1–8. A review article that describes the anatomy, clinical features, diagnostic considerations, and management of occipital neuralgia.

Narouze S. Occipital neuralgia diagnosis and treatment: the role of ultrasound. Headache. 2016;56(4):801–7. An article describing the role of ultrasound when performing occipital nerve blocks. The author suggests the ultrasound guidance allows for a more accurate performance of an occipital nerve block at the level of entrapment rather than presumed anatomical site.

Doddamani R, Meena R, Sawarker D, Aggarwal D, Chandra P. Management options in occipital neuralgia: a review. J Peripher Nerve Surg. 2020;4:7–14. A review article describes the various treatment options and their efficacy in the treatment of occipital neuralgia.

Yun JM, Lee SH, Cho JH, Kim KW, Ha IH. The effects of acupuncture on occipital neuralgia: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1):171. A systematic review on the efficacy of acupuncture in the treatment of occipital neuralgia. The authors suggest that acupuncture treatment showed significant effects compared to control group.

Viswanath O, Urits I, Jones MR, Peck JM, Kochanski J, Hasegawa M, et al. Membrane stabilizer medications in the treatment of chronic neuropathic pain: a comprehensive review. Curr Pain Headache Rep. 2019;23(6):37. A review article evaluating the efficacy of membrane stabilizer medications in the treatment of chronic neuropathic pain. The authors suggest individualized multimodal therapy to patients who suffer from chronic neuropathic pain.

Taylor M, Silva S, Cottrell C. Botulinum toxin type-A (BOTOX) in the treatment of occipital neuralgia: a pilot study. Headache. 2008;48(10):1476–81.

Williams KA, Lawson RM, Perurena OH, Coppin JD. Management of chronic migraine and occipital neuralgia in post 9/11 combat veterans. Mil Med. 2019;184(7-8):e207–11. A retrospective chart review to evaluate the effectiveness of using occipital blocks and Botox as dual therapy for reducing headaches frequency with chronic migraines, occipital neuralgia, and traumatic brain injury or neck trauma. The authors report a significant reduction in the number of headache days per month after dual therapy.

Abd-Elsayed A. The ablation technique for treating migraine headache. Curr Pain Headache Rep. 2020;24(6):29.

Sweet JA, Mitchell LS, Narouze S, Sharan AD, Falowski SM, Schwalb JM, et al. Occipital nerve stimulation for the treatment of patients with medically refractory occipital neuralgia: congress of neurological surgeons systematic review and evidence-based guideline. Neurosurgery. 2015;77(3):332–41.

Raoul S, Nguyen JM, Kuhn E, de Chauvigny E, Lejczak S, Nguyen JP, et al. Efficacy of occipital nerve stimulation to treat refractory occipital headaches: a single-institution study of 60 patients. Neuromodulation. 2020;23(6):789–95. This article provides result of a large series that suggest that occipital nerve stimulation is effective in treating various type of pain and headaches localized in the occipital region.

McNutt S, Hallan DR, Rizk E. Evaluating the evidence: is neurolysis or neurectomy a better treatment for occipital neuralgia? Cureus. 2020;12(11):e11461. A systematic review of the literature comparing neurolysis to neurectomy in the treatment for occipital neuralgia.