could this be occipital neuralgia?

[Debie__0__0]

  In my never ending quest to find an answer to my constant headache, I have stumbled across the term occipital neuralgia, and I wonder if this could possibly be my problem. All my doctors are at a loss to explain my headaches. I am even going through counselling in the hope of either finding an answer, or at least learning to live with it. This has been going on since April last year when I was admitted to ER with suspected cerebral bleed or meningitis. LP was negative for both. Brain scan normal. Yet the pain continues. It is always in the same place, at the back of my head, just above the 'bumps' at the bottom of my skull, and behind my eyeballs. It feels as if someone is pushing my eyeballs out of my head. My left eye bulges when the pain is really bad, and people even comment on my eye. I have had a scan done of my eyes and the only thing it showed was that the medial muscles were larger than normal in both eyes. The radiologist questioned the significance of that finding. The pressure in my left eye is higher than the right, but no glaucoma is present. My headache is constant, yet it goes through periods when it is unbearable. This heightened pain can be brought on by anything, or nothing. Sometimes turning my head, or coughing, or bending over will trigger it off. Could this be occipital neuralgia, or any other suggestions.
  PS my sinuses are fine, I have no allergies (food or airborne). Have just been Dx with slight sleep apnoea, but the Dr doesnt think my hedache is related to the apnoea, although he feels it may be contributing to the continual pain.
  Your advice would be greatly appreciated. I dont want to go through another year like last year!
  Thank you,
  DEBBIE
Dear Debbie:
Sorry to hear about your headache.  A couple of questions, first is there a family history of migraine, and second do you have migraines or is this the first bad headache you have ever had.  Third, have you or are you currently taking medication for the headache.  Yes, it might be occipital neuralgia.  This is due to an inflammation or compression of the greater occipital nerve as it exits between the occiput and the first cervical vetebra.  The therapy iw a soft cervical collar worn during the day, hot packs applied at bedtime and on awakening, analgesics and extensive physical therapy.  The eye is very rarely the source of the pain.  However, the MRI of the C-spine usually can pick up an inflammed nerve.  And since you had a MRI of the brain and C-spine (?) this might not be the problem.  If you have been on alot of pain medications and you previously had migraines, then this might be what is called transformed migraine.  The treatment for this is ceasation of all medications and then treatment with Elavil or Doxepin.  While you try the first approach if the MRI hasn't been done, you can try the second approach.  However, I would not do this on your own.  I would first see a neurologist who is familiar with headache.  Best of luck, let us know if we can help.
Sincerely,
CCF Neuro[P] MD