Occipital neuralgia is a condition characterized by paroxysms of stabbing/shooting pain in suboccipital region that radiates over vertex in the dermatomes of nervus occipital major in 90% or minor in 10% and both in 8.7%. Mostly it is unilateral but can be bilateral, associated with dysasthesia/parasthesia and pain on palpation and often difficult to differentiate from other headache syndromes. The greater occipital nerve receives sensory fibers from C2 and lesser occipital nerves from C2 and C3 nerve roots. It develops due to entrapment of the nerves in trapezius and semispinalis capitis muscles at the attachment to occipital bone. Local anesthetic blocks of occipital nerves at periphery or at C2/C3 roots are helpful for diagnosis. Other treatment modalities are medications, nerve blocks with steroids/Botox, Radio Frequency (RF) ablation of occipital nerves or surgical interventions.
A 35 years old lady presented with severe throbbing, burning pain in posterior part of the head bilaterally radiating to frontoparietal and occasionally retrobulbar region, that increased since 1 month. It was associated with neck pain and stiffness. The attacks were paroxysmal lasted for 4-8 hrs/4 days in a week initially, but then the frequency and duration was increased, inability to sleep and pain on touching the occipital area. There was no history of trauma/surgery.