Occipital Neuralgia: What treatments work for you?

Posted by jmb73 @jmb73, Sep 11, 2019

I have been having headaches on one side of my head and have recently been diagnosed with occipital neuralgia. They recommend a nerve bloc but I wonder anyone else has this and how they handle it.. I don't want a nerve bloc. The headaches are usually mild but occasionally the pain wakes me up. They got worse after I had my Gamma surgery. Any ideas would be appreciated. Thank you.

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It’s horrible. Try ice packs or heat. Ice works best for me, coupled with Tylenol, Celebrex and nerve stimulator. Good luck.

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Profile picture for Rachel, Volunteer Mentor @rwinney

Hi @lisa2022. I'm so sorry to hear about your difficulties with occipital neuralgia, headaches, jaw and face pain. I empathize with you. I'll share my story as food for thought.

I began having neck pain when I was 46. MRI's showed mild and moderate bulging disk and herniation. I tried PT and acupuncture to no avail. No surgical fix needed, so it was on to pain management. I had neck nerve blocks and radio frequency ablations on C4-7 for 2 years. I thought it might have been working, but not. I also was having "head pain" which encompassed migraines, cervicogenic headaches, half side, whole head, immense pressure. I couldn't lay my head on a soft pillow and slept in my living room recliner for the better part of 3 years. It was on to an occipital neuralgia diagnosis and both side occipital blocks, followed by RFA's. I also had Botox in my head, temples, forehead and shoulders. I thought that might have been helping, but not. I experienced jaw pain and face pain, among other areas. I was diagnosed with small fiber neuropathy which naturally causes nerve pain so I guessed that was my cause for everything. I got on nerve meds like Gabapentin and later Lyrica. In addition I was giving myself stomach injections of migraine meds like Emgality after trying all the triptans. Again, not much helped or was a game changer. It was a difficult, frustrating and confusing time.

I'm sharing the part of my story that is closest to yours. I always encourage people to seek out causes, fixes and cures. Get 2nd, 3rd opinions. Go to Mayo Clinic if possible. After it all, if you are still suffering, procedures and medications are not helping, doctors are out of answers, and you are becoming emotionally distressed, you may consider thinking outside the box. I came to my own conclusion of central sensitization and found this video by Dr. Sletten of the Mayo Clinic about Central Sensitization Syndrome (CSS):


My story ended with coming to the realization I had this umbrella of a chronic pain syndrome called central sensitization. All the meds, injections and procedures were not working because they were furthering the upregulation of my central nervous system and causing more harm than good. Doctors had nothing left to say or help me with. I had to help myself.

Please be mindful that if you don't find your "fix" and a way to pain relief, keep this information in your back pocket as a back up plan of action and knowledge. Hopefully, I didn't overwhelm you too much. Keep your chin up and keep persevering. I wish you good luck and positive vibes.

Will you let me know your thoughts on what I've mentioned?

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Rachel. @rwinney Maybe I missed it because I'm in excruciating pain from new onset of occipital neuralgia, but did you find a way to lessen or stop your pain? I've had small-fiber neuropathy also for 20 years, but these ice-pick headaches are new to me. Could SFN be the cause? What is the cure? I've been on Gabapentin for 3 days. At first it seemed to help. Now it feels like it isn't doing anything. I'm up to 400 mg a day now. And I'm taking extra-strength Tylenol.The pain is every few seconds right now. It's really hard to take. Any advice would be really appreciated.

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Profile picture for tessie69 @tessie69

I'd like to hear from anyone who suffers from pain from occipital neuralgia.

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Hi, @kasey7 - welcome to Mayo Clinic Connect. I appreciate your compassion and empathy for @judic0927. Sounds like you've been on a super challenging road yourself, with the TBI from your motorcycle accident leading to migraine and occipital neuralgia.

As long as you are not giving another member medical advice and instead sharing what has worked for you, you are welcome to share the names of medications that have or have not helped you. Here are the community guidelines, if you want to have a look https://connect.mayoclinic.org/blog/about-connect/tab/community-guidelines/.

kasey7, you talked about arthritis in your neck triggering the ON and migraines, almost daily. How did you find out that this was what was happening? Do you have distinct flare ups of the arthritis in your neck where you know the symptoms of ON and migraine are coming?

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Profile picture for tessie69 @tessie69

I'd like to hear from anyone who suffers from pain from occipital neuralgia.

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I have for 9+ years.

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Profile picture for Cathy @njzmom

I’ve had migraines for 40+ years and FINALLY received relief when my neuro put me on Quilipta. Almost to the day of starting that, I began experiencing a new type of headache that I thought was a tumor behind my eye. Grateful it isn’t a tumor. After significant frustration and multiple specialist referrals, I returned to my neuro, who diagnosed me with ON. She has referred me for PT, with dry needling and possible nerve oblation. My first session was terrific and all he did was deep muscle massage. I am hopeful!

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I hope you continue getting help.

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Profile picture for tessie69 @tessie69

I'd like to hear from anyone who suffers from pain from occipital neuralgia.

Jump to this post

I’ve had migraines for 40+ years and FINALLY received relief when my neuro put me on Quilipta. Almost to the day of starting that, I began experiencing a new type of headache that I thought was a tumor behind my eye. Grateful it isn’t a tumor. After significant frustration and multiple specialist referrals, I returned to my neuro, who diagnosed me with ON. She has referred me for PT, with dry needling and possible nerve oblation. My first session was terrific and all he did was deep muscle massage. I am hopeful!

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Profile picture for tessie69 @tessie69

I'd like to hear from anyone who suffers from pain from occipital neuralgia.

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I’ve had ON for a decade and have tried everything my neurologist knows about. NALU stimulator, Celebrex and Tylenol are my defenses against daily headaches.

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Profile picture for jill935 @jill935

Has anyone tried Nerve stimulation for Occipital Neuralgia?

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Yes, I’ve had a NALU stimulator for several years. It does hel!

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Profile picture for tessie69 @tessie69

I'd like to hear from anyone who suffers from pain from occipital neuralgia.

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Reach out to different types. I had trigeminal neuralgia, and it was the most excruciating pain EVER. Just took me DOWN. Full stop. To bed with a narcotic. Turned out it was due to a cracked wisdom tooth that X-rays and really expensive dental people could not detect. When my tooth literally split in two, it stopped. I experienced it again, and the bottom wisdom tooth was pulled. They DID find it was compromised!k the doctors don't confer with the dentists unfortunately and they should!
I also get occipital, but for me, it is more complicated because my cervical spine is compromised. I also have weak eyelid muscles (inherited), and I've had some eyelid muscles tucked, and it stopped on that side. The other eye needs to be done. Impinged nerves from places that no one critically looks at. Don't give up -- keep PUSHING!

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Profile picture for judic0927 @judic0927

I have self diagnosed. Have severe stabbing pain radiating up the back of my scalp and then onto my left forehead. Currently trying to treat with Advil and gabapentin without much success. I think next step would be to see a neurologist. Interested in hearing from anyone who has experience with this condition and especially someone who has had it treated successfully.

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@judic0927
I was sent to physical therapy for ON. They had me doing all kinds of neck stretching movements. It helped, but you should determine why you have it. I bought a new pillow that pushed my head up too high, and that’s when it started.

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