Re: Is this Occipital Neuralgia?

Posted By CCF Neuro[P] MD, RPS on February 27, 1999 at 15:39:45:

In Reply to: Is this Occipital Neuralgia? posted by Lori on February 27, 1999 at 13:19:20:






I have had a burning sensation on my head (all over my scalp) for two months.  Have seen two different neurologists.  The first said it was chronic tension headache, put me Prozac which caused the burning to spread head to toe.  Stopped seeing him, in the meantime my internist has put me on Neurontin (currently at 800mg tid, on fourth week of meds) and burning is back on head only.  Saw another Neuro yesterday who said it's Occipital Neuralgia and put me on Indocin for two weeks only, remaining on the Neurontin.  All tests have been negative (MRI, evoked potentials, EEG and bloodwork).  Does this sound like Occipital Neuralgia?  I can't find any info that associates it with a bilateral burning sensation.  I'm a 35yo healthy female.  Thanks for any insight.





Dear Lori:
Sorry to hear about your headache.  Occipital headache may result from inflammation, injury, or pressure on the occipital nerves, upper cervical spinal roots, dorsal horn, or sensory ganglion.  Paresthesia or algesia of the tissues of the scalp and the skin of the neck is characteristic of occipital headache.  Occipital neuralgia is referred pain from an inflammation or compression of the greater occipital nerve as it exits between the occiput and the first cervical vertebra to pierce the large cervical muscle tendinous insertions.  Usually, the pain in this disorder radiates to the eye region, but can involve radiation over the scalp to the eye.  Your headache sounds to me to be more of the former type of headache, as you describe it.  This type of headache falls into the tension-type headache class.  To prove it, one could do a nerve block and see how the headache responded.  Actually, I have not seen prozac work for this type of headache.  Probably, the best course of action at this point is to see if the indomethacin together with the neurontin works on the headache.  If it doesn't, I would try a different medication.  We usually will try a medication called elavil at small doses at bedtime and increase the dose until we see effects.  But there are other ways of treating this type of headache, so I will leave it up to your neurologist.  From what you tell me, it sounds more like an occipital headache and not occipital neuralgia.  But, to diagnose you over the internet is impossible.  Good luck, I hope you solve your headache soon.
Sincerely,
CCF Neuro[P] MD

[vicky456]

A related discussion, occipital nueralgia was started.

[vicky456]

A related discussion, pain was started.