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3 results

  • Chapter 14 - Occipital Neuralgia

  • from Part III - Chronic Pain Conditions Head and Neck
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 86-94

  • Summary

    Occipital neuralgia (ON) is a rare headache disorder mainly affecting the posteriorupper neck and posterior head region. By definition, ON is characterized by paroxysmal shooting or stabbing, sudden-onset pain that has frequent recurrence, lasting for a few minutes at a time. This pain syndrome is related to the nerve distribution that involves spinal nerves emerging from the upper cervical region that traverse to the base of the neck and run up the posterior scalp. It involves compression, injury, or trauma to greater occipital nerve (GON), lesser occipital nerve (LON), and then rarely due to third occipital nerve (TON). Conceptually, nerve entrapment between anatomical structures have been hypothesized to be a large contributing factor to the pathophysiology of ON. Most cases of ON are idiopathic with no clear etiology that is structurally identifiable. It is hypothesized that the pain from ON is due to compression, injury, or irritation (e.g. chronic instability, entrapment, trauma, inflammation) of the greater occipital nerve, lesser occipital nerve, and/or the third occipital nerve. Treatment can be conservative or interventional modalities.

  • Outcomes of Occipital Nerve Stimulation for Craniofacial Pain Syndromes

  • Philippe Magown, Werner J Becker, Zelma HT Kiss
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 5 / September 2021
    Published online by Cambridge University Press:
    25 November 2020, pp. 690-697
    • Article
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  • Objectives:

    Occipital nerve regional stimulation (ONS) is reported to improve pain in several studies. We examined long-term pain and functional outcomes of ONS in an open-label prospective study.

    Methods:

    Patients with medically refractory and disabling craniofacial pain were prospectively selected for ONS. Primary outcome was a change in mean daily pain intensity on the numeric pain rating scale (NPRS) at 6 months. Secondary outcomes included changes in NPRS, Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Pain Disability Index (PDI), Center for Epidemiologic Studies Depression Scale – Revised (CESD-R), and Short Form-36 version 2 (SF36) at last follow-up.

    Results:

    Thirteen patients (mean age 49.7 ± 8.4) diagnosed with occipital neuralgia (6), hemicrania continua (2), persistent idiopathic facial pain (2), post-traumatic facial pain (1), cluster headache (1), and chronic migraine (1) were enrolled. Mean NPRS improved by 2.1 ± 2.1 at 6 months and 2.1 ± 1.9 at last follow-up (23.5 ± 18.1 months). HIT-6 decreased by 8.7 ± 8.8, MIDAS decreased by 61.3 ± 71.6, and PDI decreased by 17.9 ± 18. SF36 physical functioning, bodily pain, and social functioning improved by 16.4 ± 19.6, 18.0 ± 31.6, and 26.1 ± 37.3, respectively. Moderate to severe headache days (defined as ≥50% of baseline mean NPRS) were reduced by 8.9 ± 10.2 days per month with ONS.

    Conclusion:

    ONS reduced the long-term NPRS and moderate–severe monthly headache days by 30% and improved functional outcomes and quality of life. A prospective registry for ONS would be helpful in accumulating a larger cohort with longer follow-up in order to improve the use of ONS.