Occipital Neuralgia



  • Occipital neuralgia (ON) is one of several described cranial neuralgias. ON is characterized by paroxysmal stabbing pain that follows the distribution of the greater or lesser occipital nerves or of the 3rd occipital nerve. Associated symptoms are tenderness over the involved nerve; allodynia; and less commonly, dysesthesia. ON symptoms overlap with migraine or cluster headache and other primary headache symptoms.
  • Diagnostic criteria
    • Paroxysmal stabbing pain, with or without persistent aching between paroxysms, in the distribution(s) of the greater, lesser, and/or 3rd occipital nerves
    • Tenderness over the affected nerve
    • Pain is eased temporarily by local anaesthetic block of the nerve.
ON must be distinguished from occipital referral of pain from the C1, C2, or upper facet joints or from tender trigger points in neck muscles or their insertions.


Estimated to be 3.2/100,000 per year (1)[C]


Etiology and Pathophysiology

  • ON is often posttraumatic or idiopathic, but diverse vascular (e.g., giant cell arteritis), neurogenic (e.g., C2 schwannoma), muscular/tendinous, and osteogenic mechanisms may underlie the nerve root irritation (2)[C].
  • The etiology of ON is unknown. Whiplash injuries causing nerve injury have been suggested. Entrapment and irritation due to myofascial spasm has been described at various locations of the nerve path.
ON may be mimicked by upper cervical myelitis, dural arteriovenous fistulas, cervical cord cavernous angiomas, neurosyphilis, and multiple sclerosis (MS).

Risk Factors

Most cases of ON are idiopathic. Whiplash and posterior cranial trauma are considered risk factors for ON.

General Prevention

As the etiology is unknown in many cases, there are no specific prevention strategies available. Avoiding posterior head trauma with proper safety measures for sports and driving and following surgical steps to avoid injury to the occipital nerve branches during surgery may help in prevention of trauma-related ON.

Commonly Associated Conditions

Associated conditions include tinnitus, scalp paresthesia, nausea, dizziness, and visual disturbances.

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