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Occipital nerve pain

Headaches are commonly experienced by Australians. These headaches can significantly vary from once a year through to some people experiencing constant unrelenting headaches. They may vary in severity, location, and triggers. They also can affect other things such as our ability to concentrate and think clearly and can also come with unhelpful side effects such as pain with bright lights, loud noises, or unpleasant smells.

While there are many causes of headaches, one particular cause which your doctor considered for you today iscalled occipital neuralgia. The occipital nerves come from the upper part of the spine and run up the back of your skull and over the top of your head. When irritated, these nerves can cause migraines, tension-type headaches,cervicogenic (neck) headaches, and can even cause facial pain (as the nerves are interconnected through your spinal cord).

Occipital nerves come from the neck, over the head and can refer behind the eye.

There are many causes for these nerves to be irritated ranging from simple posture, sleep position and genetics, through to previous traumas such as car accidents, whiplash, or previous operations to the neck or skull. The pain varies from aching through to sharp. The common management of headaches and migraine start with simple posture modification, stretching and gentle exercise.

Ensuring that you are not experiencing eye strain or posture problems in your workplace or daily activities. It is very important to address levels of stress as tension held in your neck muscles clamps down on these nerves and can trigger/worsen headaches. Working with a psychologist and doing relaxing activities such as meditation and mindfulness can be much more helpful than most people expect!

Using simple medications such as aspirin (over 16 years of age), paracetamol, and anti-inflammatories can be helpful for some people – but taking these too regularly can actually cause you to have more headaches as your body starts to become dependent on them. Opioid medications such as morphine and codeine have been used by some people however we know this leads to a difficult cycle as these medications might help settle one headache, but set the body up for having another one within hours to days after recovery. Leading to an unhelpful cycle.

There are preventative medications, particularly for migraine headaches which can also be helpful, and your doctor and GP will discuss these with you. Sometimes the headaches remain frustrating despite these measures.

Procedural options your pain doctor can discuss include diagnostic blocks of the occipital nerves. In this small procedure, done within our clinical rooms (on a separate day and when you have a driver), we place local anaesthetic (numbing injection) on these nerves to attempt to reduce your head/neck pain. This is only a DIAGNOSIS and is a temporary test lasting a few hours.

Greater and Lesser occipital nerve blocks

If the diagnostic block is successful, then we may discuss a further similar option called radiofrequency ablation which can attempt to make the pain reduction last 6-12 months in up to 70% of patients with a positive diagnostic block. While this is not a permanent fix, it often helps to ‘break the cycle’ of repeated headaches and allow you to do gentle exercises to get your neck stronger.

Some patients have this procedure performed once or twice a year to dampen their pain as they prefer having this procedure to taking regular medications and having headaches. If these procedures are very helpful, but are not lasting long enough, there are further options of a small, implanted lead (like an internal TENS machine just under the skin) next to the nerve to dampen that pain longer term with a small battery that may last for up to 8 yrs. You may discuss this further with your doctor if other measures are unsuccessful.

Your team at Resolve Pain can help guide you and include these aspects in a multidisciplinary approach to your pain when appropriate. Please ask any questions you may have at your next consultation.

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