The greater or lesser occipital nerves are sensory nerves that branch off the C2 spinal nerve. Entrapment of these nerves causes posterior scalp and upper neck pain, with pain triggered by application of pressure near the occiput. Pain may also occur behind the eyes. Patients typically present complaining of chronic headaches. As such, occipital neuralgia is commonly mistaken for tension or migraine headaches.
The main cause of this syndrome is trauma. Traumatic cervical extension and atlanto-axial subluxation can damage the C2 nerve root and ganglion. Direct injury to the greater or lesser occipital nerve may occur in surgical procedures, for instance if a suture is placed through the nerve during closure of a posterior fossa craniectomy.
Treatment of occipital neuralgia remains controversial. Most cases are self-limited. Nerve block and local steroid injection may provide temporary pain relief. For idiopathic cases, nerve decompression may be most effective. In cases of atlanto-axial subluxation, nerve decompression and atlanto-axial fusion may be recommended.
- Greenberg M. Handbook of Neurosurgery. 6th ed. New York: Thieme Medical Publishers, 2005.