It seems like you always have a headache. Your head hurts so much even your hair hurts.
Medications help for short periods of time, but it seems the best way to reduce the pain is to have someone rub the back of your head and neck. You may be suffering from occipital neuralgia.
Occipital neuralgia is a common cause of headache. It involves the two pairs of nerves that originate from the second and third vertebrae of the upper neck (C2 and C3) that become the occipital nerves.
Occasionally, either the C2 or C3 nerve root can get irritated as it leaves the spine. These nerves provide sensory information to the brain about the scalp and if they are irritated it can cause a chronic headache.
This irritation can be direct (primary) or due to an underlying disease (secondary). Secondary occipital neuralgia causes may include tumor, trauma, infection, systemic disease or hemorrhage.
Primary occipital neuralgia can be due to chronically contracted neck muscles.
Commonly, the nerves are inflamed and sensitive because they are trapped within the muscles through which they pass. Muscle spasm and pain are often associated with nerve entrapment, which causes localized pain, spasms and muscle cramping.
Other possible causes of occipital neuralgia primary relate to the health of spine such as osteoarthritis or disc degeneration that can cause irritation of the nerves. The occipital nerves can also be injured through direct trauma or tumors affecting the nerve roots.
Symptoms of occipital neuralgia include aching, burning and throbbing pain that is largely continuous. Interspaced with the continuous pain are occasional shooting pains along the course of the nerve.
The pain usually originates at the base of the skull and radiates to the back and/or side of the scalp along the course of the nerves. This pattern of pain is often compared to a ‘Ram’s Horn’.
Some suffers experience pain behind the eye on the affected side. The pain is most often only on one side of the head, but may affect both sides of the head. Neck movements may trigger pain in some people. The scalp may be tender to the touch and an activity such as brushing the hair may increase a person’s pain.
There is a constant pain at the base of the skull, and pressure on that area can either bring relief or increase the pain.
It can be difficult to distinguish occipital neuralgia from other types of headaches. The pain is often described as migraine-like and some patients experience other symptoms common to migraines and cluster headaches.
A thorough evaluation will include a review of your health history, physical examination, and possibly, diagnostic tests. If there are abnormal findings on a neurological exam, a MRI or CAT scan may be recommended.
The goal of treatment is to alleviate the pain and remove the irritation to the occipital nerves. Often, symptoms will improve or disappear with conservative care.
Conservative treatment may consist of chiropractic adjustments of the upper cervical spine, acupuncture, heat/ice, rest and massage.
Some cases may require a combined treatment approach with your medical doctor for anti-inflammatory medications, and muscle relaxants. Other medical interventions may include anticonvulsant medications, nerve blocks, and – in exceptional cases – surgery.