Neuralgia of the occipital nerve. Treatment of occipital neuralgia

Occipital neuralgia is pain in the head that occurs due to compression of the nerve roots that form the occipital nerves, or the nerves themselves. The pain in this case has a “shooting” character and becomes constant as the disease progresses.

The causes of neuralgia of the occipital nerve can be different, and in accordance with them it is customary to distinguish:

• primary neuralgia, which occurs without obvious reasons;
• secondary neuralgia, which occurs as a result of injuries, neoplasms, etc.

Symptoms of occipital neuralgia can easily be confused with clinical manifestations of other diseases, so independent diagnosis is unacceptable. In order to undergo a course of treatment for occipital neuralgia, contact the CELT Pain Clinic!

At CELT you can get advice from a specialist algologist. Make an appointment

Causes of occipital neuralgia

Treatment of occipital neuralgia is prescribed depending on the reasons that caused this pathology, and they can be very different:

• mechanical damage to the spine resulting from trauma;
• hypothermia;
• prolonged muscle tension due to a sedentary lifestyle;
• consequences of osteochondrosis;
• severe stress;
• diseases of the spine of various nature;
• diseases of infectious etiology;
• inflammation of blood vessels;
• gout;
• diabetes.

Primary and secondary prevention

Primary prevention , which is aimed at preventing the development of the disease, comes down to treating concomitant pathologies, reducing the load on the cervical spine, alternating static and dynamic loads on the occipital muscles, as well as proper nutrition.

You should also beware of general and local hypothermia. It is recommended to use an orthopedic pillow for sleeping and wear a Shants collar to relieve the muscles of the cervical spine.

Secondary prevention involves preventing exacerbations of the underlying disease and involves:

• treatment and prevention of underlying pathology (osteochondrosis and other spinal diseases, myofascial syndrome, etc.);
• active lifestyle, avoidance of excessive physical activity, proper nutrition and the use of preventive courses of vitamin therapy;
• the use of preventive courses of physiotherapy, massage, reflexology, physical therapy.

Symptoms of occipital neuralgia

Primarily, neuralgia of the greater occipital nerve is characterized by headache. Her character is very specific:

• pain is concentrated behind the ears, in the occipital region, lower part of the neck, as well as in the eye area or above them;
• attacks occur unexpectedly when turning the head or touching the area of ​​innervation, often when touching the skin of the head;
• painful sensations are localized on one side, although bilateral damage occasionally occurs;
• the pain looks like “lumbago” and disappears as suddenly as it begins;
• bright light causes pain in the eyes.

How to diagnose the disease?

Because the symptoms of the disease are extremely nonspecific, making a diagnosis is often quite difficult. It is necessary to differentiate the pathology from migraine, headaches of other origins, arterial hypertension and other diseases.

To clarify the diagnosis, a full examination is necessary, starting with a doctor’s examination and laboratory tests and ending with specific studies, among which the most important are:

• radiography of the cervical spine, which allows you to visualize bone structures, determine the presence of space-occupying formations and osteochondrosis;
• computed tomography, which makes it possible to obtain a layer-by-layer image of the structures of the cervical spine;
• Magnetic resonance imaging is the most accurate method that allows you to get an idea of ​​the structure of bones and soft tissues in the examined area.

Treatment of occipital neuralgia

Sympathetic blockade

• Cost: 8,200 rub.
• Duration: 15-30 minutes
• Hospitalization: 2 hours in hospital

More details

At the CELT Pain Clinic, medical and surgical treatment methods are used to treat occipital neuralgia:

Drug treatment

Drug treatment methods are aimed at reducing pain. For this purpose, anticonvulsants and muscle relaxants are prescribed. In addition, massage and rest are prescribed.

A procedure called nerve block has proven itself well in our Pain Clinic. It consists of injecting the drug directly into the affected area, thereby achieving a long-lasting pain relief effect.

Surgery

If pain lasts a long time, is pronounced, or if conservative treatment does not bring the desired result, our specialists will recommend the following:

• pulsed radiofrequency ablation of the occipital nerves;
• stimulation of the occipital nerves - involves conducting electrical impulses through the nerves that block pain;
• microvascular decompression - involves the use of microsurgical techniques that eliminate compression of the nerves, and therefore the pain itself.

It is worth noting that occipital nerve stimulation is a minimally invasive method that does not have similar effects and is absolutely painless.

Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

Driving directions

Treatment with folk remedies

You can try to treat this disease using traditional medicine recipes.

These recipes will help alleviate the condition:

• Sleep-herb tincture . The raw materials are poured with boiling water and kept for 24 hours. I use the product once a day. The infusion is also very effective for neurasthenia and insomnia.
• Lilac ointment . Boil lilac buds and add pork fat. The resulting ointment is rubbed into areas of the neck and head that are inflamed.
• Willow bark decoction . Pour boiling water over dry bark. Then simmer over low heat for 20 minutes. The product is taken one spoon 5 times a day.
• Horseradish compress.

It is necessary to take into account that all folk remedies are used only after consultation with the attending physician.

Diagnostics

Contacting a specialized clinic for headaches is the right decision.

There, the patient will be asked to undergo several stages of examination, but first the doctor will clarify the nature of the pain, its duration and location, and associated factors. In some cases, the examination cannot be done without the following medical tests:

— EEG; — MRI; — X-ray; - EMG; - CT; - Ultrasound.

Sometimes it is necessary to conduct laboratory tests to detect inflammation or infection, cholesterol metabolism disorders or autoimmune processes.

Efficacy of monoclonal antibody therapy

Monoclonal antibodies are administered subcutaneously by a neurologist once a month. The course of therapy is 6-12 months.

The results of clinical studies demonstrate the high efficiency and safety of monoclonal antibody therapy. Taking the drugs significantly reduces the intensity of pain and the frequency of migraine episodes. The risk of side effects is minimal. The drug has a targeted effect, without affecting metabolic processes in the liver and without changing the condition of the gastrointestinal mucosa. In this way, the systemic effect is minimized.

Neurologist Alexey Sergeev - about a breakthrough in the treatment of migraines

Breakthrough in treatment

The molecule that triggers a migraine attack, CGRP (calcitonin gene-related peptide), was discovered back in 1984. For more than 30 years, scientists have been trying to find a way to influence it in order to come up with an effective drug for the treatment of migraines. And just last year, the FDA (Food and Drug Administration) - the organization that registers and controls drugs in the United States - approved the first drug, and then a second and a third, that reduce the number of migraine attacks by blocking the activity of this molecule or its receptor. So far, the drugs are approved only for adults, but clinical studies are already underway for children. Two of these drugs are already registered in Europe. In Russia they have been at the registration stage since last year, we hope that the medicine will appear here in the fall. Therapy consists of a subcutaneous injection once a month (for one of the drugs - once every three months). In 20% of patients, attacks disappear almost completely; in the rest, the frequency of attacks decreases significantly. Now another type of drug is being developed that acts on the same molecule, which perfectly relieves pain already at the moment of an attack. Even triptans, drugs for treating moderate to severe migraines, are only 70% effective, and new drugs are expected to be more effective and better tolerated. They are currently undergoing the third stage of clinical trials. Taken together, these developments are a real breakthrough in the field of migraine prevention and treatment.

Types of headaches

Headaches can have more than 150 different causes. A headache, like any pain, can be a sign of danger when some structure in the body is damaged - a vessel, membrane, skin, joint or ligament. This pain is called symptomatic or secondary headache. In this case, doctors need to understand where the danger is, which the pain signals, and treat the cause.

But much more often, a headache is a manifestation of an independent neurological disease. Such pains are called primary, and they account for approximately 95% of all headaches. Among them, it makes sense to distinguish three main groups - tension headaches, migraines and rare but very severe variants - trigeminal autonomic cephalgia.

It happens that before a headache appears during a migraine attack, a person’s vision changes - certain flashes appear before the eyes, flickering zigzags, spots, transient numbness of the face or hand. This is called a migraine aura. According to recent data, migraine with aura is a slightly different disease than migraine without aura. Migraine attacks with aura are less common, but more severe. In certain cases, migraine with aura is treated differently.

A person does not die from primary headaches, and they usually do not lead to any complications, but they can seriously ruin life.

Photo: Maria Mozharova

Myths about migraine and unnecessary tests

There is a common myth that one of the most common causes of headaches in children and adults is related to problems in the cervical spine. In reality, such a connection is extremely rare, and in such situations we are talking about cervicogenic headache. In Russia, this term has been replaced by “cervicocranialgia” - from the words “cervical” (cervical) and “cranial” (cranial). In Russia, there is a huge overdiagnosis of this syndrome; this is a very common diagnosis in our country, although in reality this situation occurs in less than 1% of all headaches. Indeed, 80% of migraine attacks begin from discomfort in the neck, but this is explained by the fact that the trigeminal nerve system is connected by the occipital nerve. As a rule, during headache attacks, neck pain is a consequence of the onset of a migraine attack, and not its cause.

To diagnose primary forms of headaches (migraines, tension headaches), as a rule, ultrasound of the vessels of the neck and head and laboratory tests are absolutely useless. If there are warning signs of symptomatic headaches, an MRI of the brain is sometimes possible, but after consultation with a doctor. In very rare cases, for atypical migraine attacks with aura, electroencephalography (EEG) may be performed. But in most cases, performing an EEG for headaches is a waste of time and money. In general, if a doctor prescribes an X-ray of the cervical spine, electroencephalography, rheoencephalography (REG), ultrasound of blood vessels for headaches and explains the headaches as “impaired cerebral blood flow or compression of an artery in the neck,” this means that you need to see another doctor.

In 2021, a large study was conducted that analyzed the genetic data of more than 300 thousand patients to study the genetics of migraine. Scientists have identified 44 nucleotide polymorphisms associated with an increased risk of migraine. But this is not a diagnostic test system. Simply put, there are currently no biochemical or genetic tests that can confirm the diagnosis of migraine. There are only clinical criteria for diagnosis, collected based on a conversation with the patient and his examination. They are quite clear and simple. In most cases, with their help it is not difficult to diagnose migraine. All additional examinations are done only if other possible causes of headache are suspected.

Nootropics and useless drugs

While no new drugs for migraine are registered in Russia, we use drugs from the group of antidepressants, anticonvulsants and other pharmacological groups (b-blockers, Ca-channel blockers), the effectiveness of which has been proven. Drugs that supposedly improve blood circulation in the brain are ineffective for migraines and headaches. The mechanism of development of headaches and migraines, in particular, has nothing to do with circulatory disorders; this has been known and proven more than 30 years ago. There is not a single drug that “improves blood circulation.” These drugs have shown effectiveness in animal experiments, but none have shown effectiveness in human clinical studies. Apparently, all these “vascular”, “nootropic” drugs were invented not for patients, but for doctors. Treatment of chronic neurological diseases has a rather low effectiveness, and therefore, instead of explaining to patients that there is no effective therapy, it is easier to give some medicine - albeit useless, but safe. This is the use of a placebo effect, but not in a study, but in practice - beautiful words in response to the patient’s expectations, temporary improvement and no effect after one or two months.

In recent years, another common myth has appeared, born of popular TV programs, that there is a “magic” injection in the back of the head - an occipital nerve block, which supposedly instantly helps all migraine patients. People come to us and say: give me an injection as soon as possible! Unfortunately, the reality is not so optimistic. In fact, this is a really good method that has its place in the treatment of chronic migraine, but in addition to drug therapy, if this therapy is ineffective. The effectiveness of the injection was assessed in patients with chronic migraine - those who have 15 attacks per month or more. Blocking the occipital nerve leads to a reduction in attacks by several days a month - there were 15 attacks, after the injection they decreased slightly, for a short time, but there was no recovery. So this is not a panacea.

Tension headache and migraine

More than 90% of people experience tension headaches periodically in their lives. If we work for a long time in a static position at the computer, sit in gadgets, or in a stuffy room, we may experience bilateral, compressive pain in the temples or in the crown of the head. Usually it is light - on a ten-point scale, about 3-4 points. For the pain to go away, you just need to leave work, take a walk, drink coffee, breathe some air, go to training. Only if the pain lasts a long time, does not go away, and becomes stronger, does it make sense to take a pill.

Migraine is a different story, it is a disease that manifests itself as a headache plus other symptoms. As a rule, in addition to pain, an attack is accompanied by nausea, increased sensitivity to light, sounds and smells. Migraines can be bilateral or unilateral, migraine attacks can be severe or mild, but even with a mild attack, it is difficult and unnecessary to endure the pain. Without timely use of pain medication, the attack usually intensifies to severe and may be accompanied by vomiting. If you do not take medication, the attack lasts from four hours to three days. During a mild attack, simple medications can be effective - ibuprofen, paracetamol and other painkillers, which are sold in any supermarket in the world. If migraine attacks are rare - once every month or two, and a person knows a drug that helps him get rid of pain, then there is no particular need to see a doctor. There is enough information about migraine triggers, and patients themselves can figure out which triggers are relevant for them - dark chocolate, red wine, hard cheese or lack of sleep. If attacks occur more than twice a month, or if their frequency and severity begin to increase or are accompanied by other symptoms, this is a reason to consult a doctor.

As for the choice of medications, there is neither a perfectly safe drug nor any particularly strong and terrible one. Any painkiller is unsafe if used frequently or for long periods of time. For migraines, it is important to use medications in the correct dosage. For example, people often take ibuprofen 200 mg and then say that it doesn’t help them. In fact, this is a children's dosage; an adult needs at least 400 mg. The second important point is that for the drug to help, it must be taken on time and washed down with a sufficient amount of water (200–300 ml). If you draw a curve on a graph from mild to severe headache, you need to take the medicine within half an hour from the moment the pain begins to increase.

It is important to remember about the risk of developing overuse headache, or, in other words, drug-induced headache. Each medicine has its own acceptable conditional “norms” - for example, ibuprofen has no more than 15 tablets per month. Exceeding these “norms” for a long time leads to headaches occurring more often. Combination analgin-containing analgesics, beloved by many, can more quickly cause abusive headaches and are considered a reserve and not the first choice for pain relief for headaches. There are restrictions on the use of painkillers in various groups of patients, for example, ibuprofen is prohibited for pregnant women from the third trimester. Often, migraines can “fall asleep” and regress during pregnancy. But if attacks persist during pregnancy, then this is a reason to consult a doctor and clarify what can be taken and what cannot.

For moderate or severe migraine attacks, it is useless to take simple painkillers; in such cases, other medications are needed. This is a fairly large group of drugs, which are called by the general term triptans. If an attack begins with nausea, which is then followed by a headache, no matter what medications you take—triptans or simple painkillers—their effectiveness may sharply decrease. This occurs due to migraine gastrostasis - a violation of the absorption of the drug in the gastrointestinal tract. In cases where the attack begins with nausea, we can advise the patient to take an anti-nausea pill plus an anti-migraine drug - together the effectiveness will be much higher. There are special sprays with triptans in the world, in an instant form, and there is a special subcutaneous injector with triptans, effective in more than 90% of cases - they allow you to introduce the drug into the body, bypassing the gastrointestinal tract, which significantly increases their effectiveness. But, unfortunately, they are not registered in Russia - we only have ordinary triptan tablets.

Trigeminal autonomic cephalgia (TVC)

Trigeminal autonomic cephalalgias are a group of rare primary headaches characterized by very severe pain, rated 10 out of 10. They are always one-sided, in the temporal zone or eye area. This term comes from the words “cephalalgia” - headache, “trigeminal” - associated with the trigeminal nerve, and “vegetative”, because for these diseases, bright vegetative accompaniment is typical strictly on one side - lacrimation, redness of the eye, swelling of the eyelid, covering eyes. TVC attacks are short, from a few seconds to an hour and a half. Sometimes these pains are called suicidal, because cases are described when people tried to commit suicide, unable to bear it. Fortunately, today doctors have the opportunity to help patients with TVC, relieve pain during an attack and reduce their number.

Photo: Maria Mozharova

Headaches in children

Children's headaches are a separate important topic. Recently, after a sad history of trips to various local hospitals, a family from Altai came to our clinic for nervous diseases - the parents of a five-year-old boy with complaints of periodic changes in vision and headaches. After examinations, we excluded all possible symptomatic causes of pain and came to a diagnosis of migraine with aura. Unfortunately, migraines in children can begin early, between the ages of 5 and 7 years, but these attacks are typically rare and do not require any ongoing treatment. We discussed all this with our parents, and they went to their home in Altai, reassured. The child continued to play sports, and the attacks were very rare. However, this story had a continuation. The parents decided to continue to consult in different regional clinics, and within a year the child’s diagnosis was changed three times - stroke, aneurysm, increased intracranial pressure, developmental disorders and other horror stories were mentioned, which had no justification, except for the denial of the simple fact that migraine may be in children.

Unfortunately, this is a common situation. Migraine at the age of 10–17 years occurs in children as often as in adults, but in our realities it is still hidden under the dubious diagnosis of VSD, or “instability of the cervical spine,” or increased intracranial pressure. Often, some absolutely unnecessary, ineffective “vascular” drugs are prescribed. Parents come to us and say: “We started having periodic headaches somewhere in the third grade, and now we are already in the eighth grade, we constantly do examinations - we find nothing, but we are being monitored with a diagnosis of VSD.” The usual treatment for a child with a headache is huge folders of results of questionable examinations, which means terrible nerves and worry for parents, often completely in vain. And the child grows up with the feeling that he is sick with something serious and incurable.

It has been known for more than 50 years that boys experience the onset of migraine at the age of 6–7 years. In girls aged 12–13 years. In adolescence, the ratio changes to the same as in adults - girls suffer from migraines three times more often than boys. If you take all schoolchildren from 6 to 18 years old, 10% will have migraines, 40–50% will have tension headaches.

Provocateurs of headaches in children

Of course, when we meet at the initial appointment with a child complaining of a headache, it is important for us to exclude possible symptomatic causes. Sometimes a survey and a neurological examination are enough for this. It is not at all necessary to order a huge number of examinations. After making sure that the diagnosis is migraine or tension headache, the doctor must determine what triggers the attacks. In children, it is very important to understand what the headache triggers are. For example, there is such a phenomenon as the Monday morning migraine. On weekends, the child goes to bed later, and on Monday gets up at his usual 7 am - a change in sleep patterns and lack of sleep can provoke a migraine attack. Often children do not eat at school because the food there is tasteless or they are embarrassed to eat the food they brought with them - hunger, as well as sleep disturbance, is one of the most common provocateurs of migraines. In children, in many cases, the factors that lead to an increase in migraine and tension headaches lie in the psychological area. Relationships at school, family relationships, and anxiety are the main problems that can cause pain to become chronic. Therefore, treatment of childhood headaches is often carried out jointly with a psychotherapist.

If a child has 3-4 migraine attacks per month, we will try behavioral therapy first rather than drug therapy. If you establish a routine - sleep, nutrition and reduce psycho-emotional stress, add regular aerobic exercise, this alone can sometimes reduce 30-40% of headaches. But if migraine attacks are frequent, lasting three months or more, and their frequency does not decrease with non-drug therapy, then drug therapy is necessary. There are medications that can effectively reduce the number of attacks. It is important to note that these are not drugs from the “vascular” or nootropic group - their effectiveness has not been proven in the treatment of headaches, neither in adults nor in children. For the preventive treatment of migraine in children, drugs with proven effectiveness are used (b-blockers, Ca-channel blockers, some anticonvulsants and others) approved for use in pediatric practice.

For the course (preventive) treatment of tension headaches in children, there is not a single drug with proven high effectiveness. Amitriptyline, an antidepressant prescribed for chronic, daily pain, can sometimes be used, but this is a “therapy of desperation.” When treating frequent and chronic tension headaches in children, it is correct to concentrate on cognitive-behavioral psychotherapy, analyzing the situation in the family, at school, and solving problems that cause stress in the child.

Abdominal migraine and other unusual variants of migraine in children

In children, migraine can manifest itself as more than just a headache. There is a separate group of conditions associated with migraine in children. For example, abdominal migraine is not manifested by headaches, but by periodic abdominal pain. Children with migraines may also often experience kinetosis - a tendency to motion sickness in transport. Another option for the equivalent of a migraine is attacks of dizziness, which occur suddenly, last from several minutes to several hours, and disappear without a trace. There is a known syndrome of cyclic vomiting in children 4–6 years old, when vomiting develops many times during the day, not associated with either metabolic or gastroenterological disorders. It is important to keep in mind that such childhood periodic syndromes can be considered as equivalent to migraine only after excluding all possible other causes - gastroenterological, neurological, ENT pathology (for episodes of dizziness), etc. All these symptoms, as a rule, require examination and only can then be diagnosed as a childhood variant of migraine.

About the diagnosis and treatment of headaches in Russia

I just had a second-year student at a Moscow medical university at my appointment. From the age of 14, she was given pointless nootropic drugs once every six months, supposedly for headaches. At first she felt better, and then after a couple of months it got worse. The trigger for her migraines was actually an anxiety disorder that was untreated. Now she already has chronic migraines, she takes more than 30 painkillers a month, she has anxiety panic disorder and sleep disturbances - the girl is forced to take academic leave.

There are many such undiagnosed and neglected cases, but in general it is worth noting that the situation in Russia is beginning to change in a positive direction. Modern Russian clinical recommendations for the diagnosis and treatment of headaches were developed by my colleagues; they are absolutely adequate and meet international standards.

I teach to students and lately I have seen that most of the younger generation of doctors strives for modern knowledge and does not think of themselves in isolation from global practice and medical science. Recently, at Sechenov University, my colleagues and I received an educational grant and developed a program for students, residents and doctors “Diagnostics and treatment of headaches.” In parallel, colleagues from the university headache clinic conducted the first educational course on the treatment of headaches under the auspices of the European Headache Federation. Many young doctors are interested in the problem and strive to receive objective information about the diagnosis and treatment of headaches in children and adults. I really hope that this will ultimately turn the Russian situation around.

Asya Chachko