Occipital Neuralgia: What treatments work for you?

@jmb73 @bumble81 I also get occipital headaches that happen on the back of my head on one side. For me it is a physical problem that is caused by a slight misalignment of the upper cervical vertebrae, usually C1 & C2 that are caused by muscle spasms in my neck. Essentially, when the the skull doesn't sit correctly on top of the spine, it causes the muscles on the back of the head to complain. I had a whiplash 20 years ago, and had muscles spasms ever since that, and eventually spine surgery for a ruptured C5/C6, and now after surgery, the muscle spasms are infrequent and my neck is maintaining the correct curvature alignment. I had a lot of cervicogenic headaches prior to spine surgery.

A physical therapist who is knowledgeble with spine surgery rehab can probably help this type of issue. The best advice is to first evaluate with a specialist for any instability at the upper cervical vertebrae and skull. No one should attempt to realign anything in the spine if there is instability because it causes slippage of vertebrae past each other and can be very serious if that happens right under the skull and effects the spinal cord. If things are stable, then a physical therapist can work on the problem. A PT should always insist of imaging and an evaluation first before they do any work on a patient, or they can risk injuring the patient.

I can still trigger a slight issue that causes independent rotation of C1 and C2 if I sleep wrong or get a neck/shoulder spasm from overexertion. I am a lot more aware of this now from working with my physical therapist. I can also stop the spasm when it starts by bracing one arm and pushing my head back toward that side that hurts against resistance from my other arm. The reason that works is because there is a muscle that connects C1 and the spine and the other end connects to the shoulder blade. So when I brace my arm, I am stopping the shoulder blade from moving at that end of the muscle, so the muscle can pull against the resistance and move the other end which is attached to the side C1 which rotates C1 back in place. That is my body's pattern and yours may be different. Working with a physical therapist can really help.

I have it. It actually got better and stayed better for years and then I had surgery to remove my uterus. As soon as I woke up I asked for pain meds because my head hurt so bad. And then it stayed that way for a year. Now it just hurts when it gets aggravated by being touched. I suspect the base of my head was resting on something during surgery and that is why it came back after surgery.
I believe my ON was caused by a fall off a horse.