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2016 ; 31
(4
): 479-88
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Neuralgias of the Head: Occipital Neuralgia
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Choi I
; Jeon SR
J Korean Med Sci
2016[Apr]; 31
(4
): 479-88
PMID27051229
show ga
Occipital neuralgia is defined by the International Headache Society as
paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser
occipital nerve. Various treatment methods exist, from medical treatment to open
surgical procedures. Local injection with corticosteroid can improve symptoms,
though generally only temporarily. More invasive procedures can be considered for
cases that do not respond adequately to medical therapies or repeated injections.
Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but
there is a tendency for the pain to recur during follow-up. There also remains a
substantial group of intractable patients that do not benefit from local
injections and conventional procedures. Moreover, treatment of occipital
neuralgia is sometimes challenging. More invasive procedures, such as C2
gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression,
neurectomy, and neurolysis with or without sectioning of the inferior oblique
muscle, are now rarely performed for medically refractory patients. Recently, a
few reports have described positive results following peripheral nerve
stimulation of the greater or lesser occipital nerve. Although this procedure is
less invasive, the significance of the results is hampered by the small sample
size and the lack of long-term data. Clinicians should always remember that
destructive procedures carry grave risks: once an anatomic structure is
destroyed, it cannot be easily recovered, if at all, and with any destructive
procedure there is always the risk of the development of painful neuroma or
causalgia, conditions that may be even harder to control than the original
complaint.
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