title: 8. Occipital neuralgia.
abstract: Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major and/or nervus occipitalis minor. The pain originates in the suboccipital region and radiates over the vertex. A suggestive history and clinical examination with short-term pain relief after infiltration with local anesthetic confirm the diagnosis. No data are available about the prevalence or incidence of this condition. Most often, trauma or irritation of the nervi occipitales causes the neuralgia. Imaging studies are necessary to exclude underlying pathological conditions. Initial therapy consists of a single infiltration of the culprit nervi occipitales with local anesthetic and corticosteroids (2 C+). The reported effects of botulinum toxin A injections are contradictory (2 C+/-). Should injection of local anesthetic and corticosteroids fail to provide lasting relief, pulsed radio-frequency treatment of the nervi occipitales can be considered (2 C+). There is no evidence to support pulsed radio-frequency treatment of the ganglion spinale C2 (dorsal root ganglion). As such, this should only be done in a clinical trial setting. Subcutaneous occipital nerve stimulation can be considered if prior therapy with corticosteroid infiltration or pulsed radio-frequency treatment failed or provided only short-term relief (2 C+).
authors.affiliation: Department of Anesthesiology and Pain Management, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Pascal
authors.initials: P
authors.lastname: Vanelderen
authors.forename: Arno
authors.initials: A
authors.lastname: Lataster
authors.forename: Robert
authors.initials: R
authors.lastname: Levy
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
authors.forename: Jan
authors.initials: J
authors.lastname: Van Zundert
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D019547:Neck Pain / Q000209:etiology; D009407:Nerve Block / Q000379:methods; D009437:Neuralgia / Q000150:complications / Q000473:pathology / Q000628:therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use; D009777:Occipital Bone / Q000473:pathology*
chemical_list: D000305:Adrenal Cortex Hormones; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A