Occipital neuralgia is a neuropathic pain condition involving irritation or entrapment of the greater or lesser occipital nerves, which arise from the upper cervical spine. Pain is typically sharp, shooting, or electric, radiating from the base of the skull to the scalp and sometimes behind the eyes. It is often accompanied by scalp tenderness and hypersensitivity.
Causes include trauma (such as whiplash), cervical spine arthritis, muscle tension, nerve entrapment in fascia, or idiopathic origins. The condition may overlap with cervicogenic headache or migraine, complicating diagnosis.
The prevalence is uncertain but thought to be underdiagnosed; it is more common in middle-aged adults and has a higher incidence in those with cervical musculoskeletal disorders.
Treatment strategies involve conservative measures such as physical therapy, posture correction, and anti-neuropathic medications. Diagnostic and therapeutic occipital nerve blocks are often highly effective. For persistent cases, pulsed radiofrequency ablation, neuromodulation (occipital nerve stimulation), or surgical decompression of the nerve may be considered.