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13.4 Occipital neuralgia


Unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp, in the distribution(s) of the greater, lesser and/or third occipital nerves, sometimes accompanied by diminished sensation or dysaesthesia in the affected area and commonly associated with tenderness over the involved nerve(s).

Diagnostic criteria:
  1. Unilateral or bilateral pain in the distribution(s) of the greater, lesser and/or third occipital nerves and fulfilling criteria B-D
  2. Pain has at least two of the following three characteristics:
    1. recurring in paroxysmal attacks lasting from a few seconds to minutes
    2. severe in intensity
    3. shooting, stabbing or sharp in quality
  3. Pain is associated with both of the following:
    1. dysaesthesia and/or allodynia apparent during innocuous stimulation of the scalp and/or hair
    2. either or both of the following:
      • a) tenderness over the affected nerve branches
      • b) trigger points at the emergence of the greater occipital nerve or in the distribution of C2
  4. Pain is eased temporarily by local anaesthetic block of the affected nerve(s)
  5. Not better accounted for by another ICHD-3 diagnosis.

The pain of 13.4 Occipital neuralgia may reach the fronto-orbital area through trigeminocervical interneuronal connections in the trigeminal spinal nuclei.

13.4 Occipital neuralgia must be distinguished from occipital referral of pain arising from the atlantoaxial or upper zygapophyseal joints or from tender trigger points in neck muscles or their insertions.