Occipital Neuralgia or C2 Neuralgia is a form of headache in which there is throbbing electric-shock like pain in upper neck, back of head, and behind ears generally occurring on one side of head. The pain generally begins in neck and then slowly radiates upward. Some people may also have pain in forehead, scalp, and behind eyes and there maybe tenderness in the scalp and eyes become sensitive to light. The pain is located in areas supplied by greater and lesser occipital nerve, which runs from area where spinal column meets neck to scalp at back of head.
Occipital Neuralgia or C2 Neuralgia can often be confused with migraine or other types of headache because the symptoms can be similar, but occipital neuralgia is a distinct disorder that requires an accurate diagnosis to be treated properly.
Classification and Types of Occipital Neuralgia or C2 Neuralgia
There Are Two Major Types of Occipital Neuralgia or C2 Neuralgia:
- Greater Occipital Neuralgia: Greater occipital neuralgia is a common type of posttraumatic headache, but is also seen in patients without injury. The pressure, aching, stabbing, or throbbing pain may be in a nuchal-occipital, temporal, parietal, frontal, periorbital, or retro-orbital distribution. The headache may last for minutes or hours to days and can be unilateral or bilateral.
- Lesser Occipital Neuralgia: Lesser occipital neuralgia is similar to that of greater occipital neuralgia, but the pain generally refers more laterally over the head.
Pathophysiology of Occipital Neuralgia or C2 Neuralgia
The pathophysiology of Occipital Neuralgia or C2 Neuralgia is unknown although it may by secondary to whiplash injuries as well as systemic or local diseases. It is believed to be related to increased muscle activity in the cervical region or entrapment of the second cranial nerve root by paravertebral structures.
Causes and Risk Factors of Occipital Neuralgia or C2 Neuralgia
Occipital Neuralgia or C2 Neuralgia can be caused by multiple different factors the most common cause being a head trauma. Neck injury such as a whiplash may result in damage and inflammation to the occipital region causing pain and nerve irritation. Occipital Neuralgia or C2 Neuralgia may be caused due to pinching or entrapment of the nerve root in the neck with the most common causes being tumors, tight muscles, and some spine conditions. Diabetes or gout may also cause occipital neuralgia, but are less common. However, the cause is unknown is some of the cases.
A good number of medical conditions are being associated with Occipital Neuralgia or C2 Neuralgia.
Risk Factors for Occipital Neuralgia or C2 Neuralgia May Include:
- Trauma to the back of the head.
- Neck tension and/or tensed neck muscles.
- Cervical disc disease.
- Infection or inflammation of the muscles and nerves.
- Tumors in the neck.
- Inflammation of blood vessels.
- Exposure to chemicals.
Signs and Symptoms of Occipital Neuralgia or C2 Neuralgia
Occipital Neuralgia or C2 Neuralgia causes intense pain, damage and dysfunction of the nerves and muscles in the occipital region, which is located at the back of the neck. This may result in a many symptoms. The symptoms may vary in intensity depending on severity.
Occipital Neuralgia or C2 Neuralgia can cause very intense pain that feels like a jabbing, sharp electric shock like sensation in the back of the head and neck.
Other Symptoms for Occipital Neuralgia or C2 Neuralgia May Include:
- Burning, aching and throbbing pain that starts typically at the base of the head and radiates to the scalp.
- Pain can be on one side or both sides of the head.
- Sensitivity to light.
- Pain behind the eye.
- Scalp tenderness.
- Pain when moving the neck.
Treatment of Occipital Neuralgia or C2 Neuralgia
Treatment for Occipital Neuralgia or C2 Neuralgia depends on what is causing the inflammation or irritation of the occipital nerves. Primary treatment consists of pain relievers or analgesics that may be effective in reducing the pain.
For Mild Symptoms Of Occipital Neuralgia or C2 Neuralgia, Over-The-Counter Pain Medications May Be Prescribed Which Include:
- Acetaminophen in the form of Tylenol.
- Ibuprofen, Advil or Motrin.
- Naproxen or Aleve.
There Are A Number Of Other Things Can Be Tried To Relieve The Pain Including:
- Applying heat to the neck.
- Resting in a quiet room.
- Massage of the tight and painful neck muscles.
Prescription Drugs May Include:
- Muscle relaxants.
- Anticonvulsant drugs, such as Neurontin and Tegretol.
- Antidepressant medications.
- Short-term use of nerve blocks and steroid injections.
Surgery may be considered if pain does not respond to conservative treatments.
Surgery May Include:
- Occipital Nerve Stimulation: A neurostimulator is used to deliver electrical impulses to the occipital nerves. These impulses help in blocking the pain messages to the brain.
- Microvascular Decompression: During this procedure, pain is relieved by identifying and adjusting the blood vessels that may be compressing the nerve.
Diagnosis for Occipital Neuralgia or C2 Neuralgia
A thorough medical history, headache history and physical examination are to be done to analyze the symptoms and rule out various disease processes.
Generally, the diagnosis of occipital neuralgia is made by eliciting tenderness over the affected nerve. Tests may include:
- Anesthetic nerve blocks are also used to confirm the diagnosis.
- Magnetic resonance imaging (MRI).
- Computed Aided tomography (CT or CAT scan).