You are not alone. There are many of us suffering from painful, debilitating Occipital Neuralgia. I was diagnosed 4.5 years ago when my symptoms started abruptly after getting the Moderna Covid Vaccine. After several nerve blocks, I was referred for a radiofrequency ablation which provided 20 months of full relief until late 2023. I had moved during that time and had to find new doctors. I was put on multiple medications and each time would get a little relief only to have ON pain return. I did consider occipital nerve decompression surgery earlier this year and even had a consult with a leading ON Peripheral Nerve Surgeon. But the percentages weren’t convincing enough, plus some risk that condition could end up worse. Now I finally have a medical team led by several Migraine neurologists and pain specialists. Due to the refractory nature of my condition, I am currently on a comprehensive, multimodal regimen targeting both central and peripheral pain generators. This includes high-dose neuropathic modulation (Gabapentin ) and muscle relaxants (Tizanidine) for Occipital Neuralgia, combined with a tiered migraine protocol involving CGRP inhibitors (Ajovy), abortive therapies (Ubrelvy, Zolmitriptan), and the Botox PREEMPT protocol. This pharmacologic strategy is being augmented with interventional management, including Occipital Nerve blocks and a scheduled Radiofrequency Ablation (RFA) early next year. I wish you the best in your treatments and return to heath. This is a horrible condition. One can only hope new research and treatments will be discovered.