Occipital neuralgia

Most sensation in the back and top of the head travels to the brain via the two greater occipital nerves — one on each side. These nerves emerge from between the vertebrae of the upper neck, pass through the muscles at the back of the head, and extend into the scalp, sometimes reaching nearly as far forward as the forehead. They do not supply the face or the area near the ears.

When one of these nerves is irritated anywhere along its course, it produces a shooting, electric, or tingling pain very similar to trigeminal neuralgia, but confined to one side of the scalp rather than the face. The pain may also radiate forward toward one eye. In some patients the scalp becomes so sensitive that washing the hair or resting on a pillow is nearly impossible. Numbness in the affected area and extreme tenderness where the nerves enter the scalp are also common.

**Causes:** Occipital neuralgia may occur spontaneously, or from a pinched nerve root in the neck (due to arthritis, for example), prior injury, or surgery to the scalp or skull. Tight muscles at the back of the head can also entrap the nerves.

**Important note:** True isolated occipital neuralgia is relatively rare. Many headaches — especially migraines — repeatedly involve the back of the head and inflame the greater occipital nerve, leading to diagnostic confusion. These cases are generally classified as migraines involving the greater occipital nerve rather than occipital neuralgia itself.