@snowmass
You will want to go to a neurologist for EMGs for upper/lower limbs, nerve conduction studies and small fiber neuropathy skin punch biopsy. This can help narrow down the source of neurological pain/sensations. I have cervical spondylitic myelopathy at C5-C6 and my symptoms included headaches, neck/shoulder blade pain and knots, harm/hand weakness, bladder issues, and walking/balance issues (felt like I had cement boots on). I had ACDF surgery to remove injured disc and osteophytes/bone spurs and then fused C6C6 and put in a titanium cage to support my cervical spine. My symptoms improved. It is important to address cervical spine issues promptly because they can cause permanent damage to spinal cord/nerve roots that send signals below that level of your spine. I am 54 years old and also need to have surgery on L4-L5 (possibly L3-S1), have idiopathic small fiber neuropathy which caused burning and pins/needle sensations and can cause autonomic nervous system issues (affecting organs/blood vessels/muscles). My gallbladder just stopped working as an example (7% bile ejection when it should be a minimum of 35-40%). I also have bilateral gluteal tendinopathy and bilateral hamstring high grade partial tears (not sure how that happened)! Not sure which surgery to have first and wasn’t expecting to be practically disabled at this age. I was a highly productive professional and now only operating at 10-20% my former self. It really does a number on your mental health. I am taking one day at a time and trying to figure out what to do because I am currently unemployed, a single parent of a teen son and his sole supporter, and no family/support system.

@snowmass
I meant to say my ACDF surgery was at C5-C6 level. Also, I wonder if your cervical issues or if you have small fiber neuropathy are causing your occipital neuralgia. Don’t let doctors say “others with your MRIs have no symptoms at all” because you are you and experiencing your symptoms which are real and affecting your quality of life. Make sure you advocate for yourself, ask lots of questions and don’t let doctors dismiss your symptoms. They need to really listen to your symptoms plus look at neuropathy blood tests/MRIs/nerve conduction test results/small fiber neuropathy results. If your doctors don’t listen to you or are dismissive, find new doctors who actually want to help diagnose and treat you properly to improve your quality of life.