Abstract
Objective. To establish differential diagnosis in patients presenting occipital neuralgia, tension-type headache, and migraine with aura. Method. We analyzed 32 patients with Occipital neuralgia (mean age=38.0; females=75%), 102 with tension-type headache (mean age=33.0; females=92.2%), and 16 with migraine without aura (mean age=37.0; females=56.3%). The specific symptoms of headaches were used in according to International Classification of Headache Disorders (ICHD) in patients with for craniomandibular disorders and bruxing behavior. Results. Occipital neuralgia group presented more nausea (78.1%; p=0.0001), vomiting (62.5%; p=0.0001), photophobia (71.8%; p=0.0001), throbbing (53.1%; p=0.0001), stabbing pain (78.1%; p=0.0001), severe pain (93.7%; p=0.0001), burning (68.8%; p=0.0001), and occipital nerve tenderness (100%; p=0.0001) than tension-type headache group. Occipital neuralgia group showed more stabbing (78.1%; p=0.0001), burning (68.8%; p=0.0005), and occipital nerve tenderness (100%; p=0.0001) than migraine without aura group. Migraine without aura group showed more vomiting (94%; p=0.03) and photophobia (100%; p=0.02) than occipital neuralgia group. Conclusions. Nausea, vomiting, photophobia, throbbing, stabbing, severer pain, a burning description and occipital nerve tenderness, better differentiated occipital neuralgia from tension-type headache. Stabbing pain, burning and occipital nerve tenderness, better differentiated occipital neuralgia from migraine without aura.
Highlights
Chronic pain conditions in the head, face or neck, have been considered a confusing area with a paucity of progress in the understanding of the pathophysiology of craniofacial pain
occipital neuralgia (ON) is described as unilateral or bilateral paroxysmal, lancinating, stabbing or shooting, throbbing, burning, intermittent, electric-shock like, continuous and/or intermittent pain of moderate to severe intensity, usually short lasting, with diminished sensation in the distribution of the greater occipital nerve (GON) and/or lesser occipital nerves, presenting with a pain generator area in the occipital/sub-occipital region associated with a tender local area, pain reproduced with pressure over the pain generator area, and usually radiating to the vertex, frontal, orbital, and peri-orbital regions[2,4,6]
When comparing some specific symptoms in ON and Tension type-headache (TTH) we found that more patients in ON group presented 78.1% nausea (p
Summary
Chronic pain conditions in the head, face or neck, have been considered a confusing area with a paucity of progress in the understanding of the pathophysiology of craniofacial pain. Headache is one of the most common complaints brought to doctors in most countries[2] and researchers consider occipital neuralgia (ON) as a subset of cervicogenic headache disorders involving structures innervated by C1, C2, C3, and the trigeminal nerve (TN), including the posterior scalp, periorbital, temporal, lower jaw, external ear, mastoid, neck and shoulder regions[3]. Some patients report pain behind the eye, in the middle facial third and in the frontal and temporal regions; a territory of the fifth cranial nerve[2]
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