Occipital neuralgia (OccN) is a somewhat rare form of headache that affects about 3 in 100,000 people a year. How is OccN different than other forms of headache and what treatment approach might a doctor of chiropractic take to manage the condition?

This type of headache is characterized by a sharp, shooting pain that radiates into the back of the head, and it’s often felt at the top of the head or above an ear, depending on which of the three occipital nerves are irritated (C1-3). Additional symptoms may include aching, burning, or throbbing that may be only on one side of the head or both. If the trigeminal nerve is also affected, the patient may feel pain in the orbit or behind the eye. Patients may also report light sensitivity, scalp tenderness, and pain when moving the neck.

Occipital neuralgia is a secondary form of headache, which means it has a known cause. In the case of OccN, the underlying cause can be neck or head trauma, neck muscle tension, neck osteoarthritis, neck tumors, cervical disk disease, infection, gout, diabetes, and/or blood vessel inflammation the irritates the occipital nerves that exit out of the upper neck or cervical spine and run into the scalp.

During the chiropractic examination, your doctor of chiropractic will be on the lookout for red flags or non-musculoskeletal causes, like suspected infection or a tumor, that would be reason to refer you to the emergency room or your medical physician. If necessary, diagnostics like x-ray or more advanced imaging may be utilized to provide a clear picture of the cause of injury to formulate a treatment plan.

A literature review published in 2020 recommended that initial care for OccN should be a conservative approach that’s focused on alleviated muscle tension and postural improvement—common goals embraced by most, if not all, chiropractors.

A chiropractic treatment plan for OccN would likely include manual therapies, like spinal manipulation and mobilization, complemented by modalities, at-home exercises targeting the cervical muscles, nutrition advice, and other forms of self-care, like heat/ice.