title: Fluoroscopy and sonographic guided injection of obliquus capitis inferior muscle in an intractable occipital neuralgia.
abstract: Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Ok Sun
authors.initials: OS
authors.lastname: Kim
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Jeong
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Ro
authors.forename: Duck Kyoung
authors.initials: DK
authors.lastname: Kim
authors.forename: Young Cho
authors.initials: YC
authors.lastname: Koh
authors.forename: Young Sin
authors.initials: YS
authors.lastname: Ko
authors.forename: So Dug
authors.initials: SD
authors.lastname: Lim
authors.forename: Hwa Yong
authors.initials: HY
authors.lastname: Shin
authors.forename: Hae Kyoung
authors.initials: HK
authors.lastname: Kim