Occipital Neuralgia: If Pain Relievers and Nerve Blocks Don't Work

Hello, this is Baekrokdam Korean Medicine Clinic.

"My head hurts with a stabbing pain, and it gets worse every time I move..."

This patient is in her mid-50s and underwent surgery for kidney and breast cancer several years ago, maintaining consistent health management. After her cancer treatment, she had been meticulously caring for her body. However, about a month ago, after experiencing cold symptoms, she began to suffer from persistent occipital pain.

At first, she attributed it to an aftereffect of her cold, but a sharp, throbbing pain manifested at the back of her head, predominantly in the occipital region. The pain intensified with movement or head shaking, significantly disrupting her daily life. Although warming the back of her neck with her hand offered some temporary relief, the pain persisted.

Ms. Lee visited a hospital where she was informed of the possibility of occipital neuralgia. Due to difficulties with medication, she then sought treatment at our Korean medicine clinic.

What is Occipital Neuralgia?

Occipital neuralgia is a type of neuropathic pain that arises when the Greater Occipital Nerve or Lesser Occipital Nerve, located at the back of the head, becomes damaged or irritated.

Main Symptoms

• Stabbing Pain: Characterized by a sharp pain that originates at the back of the head and radiates over the scalp.
• Worsening with Activity: Pain may intensify with head-turning or shaking movements, or when transitioning from a seated to a standing position.
• Sensory Abnormalities: Symptoms such as numbness, burning, or hypersensitivity may accompany the pain in the occipital region.
• Neck and Shoulder Stiffness: Tension in the back of the neck and shoulders can accompany and exacerbate the pain.

Why Does It Occur?

• Muscle Tension: Excessive stress or poor posture can lead to tension in the neck and shoulder muscles, resulting in nerve compression or irritation.
• Trauma: Nerves may be damaged due to accidents or physical impacts.
• Inflammation: Inflammation after a cold or viral infection can also commonly irritate the nerves.
• Other Factors: Cervical spine issues (e.g., disc herniation, arthritis) or blood flow disorders can also be contributing factors.

Occipital Neuralgia: A Korean Medicine Approach

The patient was diagnosed with occipital neuralgia and experienced significant symptom improvement after receiving acupuncture treatment at our Korean medicine clinic. The treatment proceeded as follows:

1. Acupuncture Treatment

Acupuncture treatment is known to be an effective method for patients with occipital neuralgia. Treatment focused on the following acupoints:

• Fengchi (GB20): Located at the back of the neck, where the greater occipital nerve is situated, this point is effective in relieving nerve compression and reducing pain.
• Trigger points around the shoulders: Stimulating tense areas of the shoulder muscles helps relieve tension in the neck and occipital region.
• Acupoints of the Gallbladder Meridian: Acupoints on the Gallbladder Meridian (e.g., Jianjing GB21, Yangbai GB14) are selected to promote the circulation of qi and blood in the head and neck.

After treatment, she reported significant alleviation of pain, with a considerable reduction in the severe pain she experienced during movement.

2. Lifestyle Management

Lifestyle improvements and management significantly contribute to alleviating symptoms of occipital neuralgia. The following lifestyle management methods were recommended to Ms. Lee:

• Keep the neck warm: Protecting the neck and occipital region in cold environments can alleviate symptoms. It is advisable to use a scarf or a heating pad.
• Maintain proper posture: When sitting or standing, maintain a posture that avoids strain on the neck and shoulders. Especially during long hours of computer work, she was advised to take breaks for stretching.
• Avoid excessive movements: Refrain from sudden head turns or shaking movements, and be cautious not to irritate the nerves during activities.

3. Korean Medicine Treatment as an Alternative to Medication

Although taking herbal medicine was difficult after her cancer treatment, we supported qi and blood circulation around her neck through thermotherapy and moxibustion. Moxibustion helps reduce neuropathic pain symptoms by warming the body.

Advice for Patients with Occipital Neuralgia

• Relax your neck and shoulder muscles: Occipital neuralgia is deeply related to neck and shoulder tension. Gentle stretching and massage can help alleviate pain by relaxing these muscles.
• Maintain a warm environment: Cold temperatures can exacerbate pain. Keep your neck and occipital region warm to help prevent pain.
• Avoid excessive movements: Sudden head movements or strenuous exercise can trigger pain. Adjust your activity intensity until your symptoms improve.
• Consider acupuncture treatment: Even when medication is difficult to take, acupuncture treatment can offer pain relief for occipital neuralgia. Stimulating appropriate acupoints can significantly reduce symptoms.

In my personal experience, I have observed a significant number of cases where patients with chronic occipital neuralgia, who did not respond well to analgesics and showed limited treatment efficacy even after nerve blocks, surprisingly responded well to Korean medicine treatment.

If you are suffering from occipital neuralgia, try managing your symptoms with acupuncture treatment and lifestyle improvements.