Treatment Of Occipital Neuralgia Research Articles

Noninvasive Pulsed Radio Frequency Energy in the Treatment of Occipital Neuralgia with Chronic, Debilitating Headache: A Report of Four Cases

To examine the effects of noninvasive pulsed radio frequency energy (PRFE) on recurrent migraine headache associated with occipital neuralgia. Four patients who were receiving long-term treatment with repeated greater and lesser occipital nerve blocks (GLONBs) to control recurrent migraine resistant to other treatment underwent treatment with noninvasive PRFE at home as a substitute for GLONB treatment. PRFE was administered by the patient at home for 30 minutes twice daily through an applicator pad placed directly over the occiput and upper cervical spine. Three of four patients reported a decrease in frequency, severity, or both of nonprostrating and prostrating migraines compared with their baseline symptoms; one reported no change from baseline. Comparing PRFE results with those obtained after nerve blocks, three of four patients reported decreases in nonprostrating migraines, while two reported a decrease in prostrating migraines. One patient reported an increase in prostrating migraine frequency. Variable degrees of increased productivity, decreased opioid and nonopioid analgesic use, and decreased visits to urgent care clinics were noted. In two patients who had combined PRFE and GLONB, marked improvement was noted in all symptoms. Improvement in frequency of headaches was noted, especially when PRFE was combined with GLONB. Further study is warranted.

Benefits of Sonographic Examination for Diagnosis and Treatment of Occipital Neuralgia.

Occipital neuralgia a type of headache that involves irritation and inflammation of the Greater Occipital Nerve (GON). Diagnosis of this headache is achieved mainly through clinical examinations where tenderness is noted along the distribution of the GON. However, anatomical studies have demonstrated its various course and distribution that may be distant from the conventional landmarks where routine anesthetic injectate is administered “blindly”. Furthermore, GON may have multiple branches that unless the most proximal nerve is not approached, injection may not be complete. Therefore, utilization of sonography can add benefits for diagnostic work-up and treatment of occipital neuralgia by enabling accurate localization of and measurement of the cross-sectional area (CSA) of GON.

Occipital Nerve Stimulation for Headache Disorders

Occipital nerve stimulation (ONS) was originally described in the treatment of occipital neuralgia. However, the spectrum of possible indications has expanded in recent years to include primary headache disorders, such as migraine and cluster headaches. Retrospective and some prospective studies have yielded encouraging results, and evidence from controlled clinical trials is emerging, offering hope for refractory headache patients. In this article we discuss the scientific rationale to use ONS to treat headache disorders, with emphasis on the trigeminocervical complex. ONS is far from a standardized technique at the moment and the recent literature on the topic is reviewed, both with respect to the procedure and its possible complications. An important way to move forward in the scientific evaluation of ONS to treat refractory headache is the clinical phenotyping of patients to identify patients groups with the highest likelihood to respond to this modality of treatment. This requires multidisciplinary assessment of patients. The development of ONS as a new treatment for refractory headache offers an exciting prospect to treat our most disabled headache patients. Data from ongoing controlled trials will undoubtedly shed new light on some of the unresolved questions.

Peripheral Nerve Surgery: New Advances in the Treatment of Occipital Neuralgia and Headaches

According to the National Headache Foundation, an estimated 28 million Americans suffer from migraines. Women are three times more likely to suffer from migraines than men, and 70 to 80% have a family history of migraines. This has significant impact on the quality of life of these patients, as well as days lost from work. Recent reports indicate involvement of several nerves in headache generating pain (supraorbital, supratrochlear, zygomaticotemporal, and greater occipital). It is also postulated that muscle spasm, in addition to an abnormal nerve path, leads to a nerve compression and thus to symptomatic migraine headache.

(790): Botulinum toxins in the treatment of occipital neuralgia

Myobloc® (Botulinum toxin type B) is FDA-approved for the treatment of cervical dystonia(CD). However, Myobloc has also demonstrated utility in treating a number of chronic pain conditions, including myofascial and low back pain, headache and neuropathic pain. The following case reports represent its use in the treatment of occipital neuralgia. GN was a 43 year-old right-handed female with a nine-year history of daily headaches localized to the forehead and occipital area. Initial neurological exam showed spasms tenderness over the occipitocervical junctions. MRI of the brain with and without contrast was normal. Numerous medications including nortriptyline, gabapentin, topiramate, levatiracetam, nadolol, phenobarbital, tramadol were ineffective or not tolerated. She had word-finding difficulty with topiramate. A series or three bilateral occipital nerve blocks (combination of local anesthetic and steroid) provided complete headache relief for two weeks each. Myobloc (5000 units) was added to local anesthetic and provided headache relief for greater than 2 months. PG was a 53 year-old female with right occipital neuralgia. She failed oral agents and was treated with BT-A 100 units and local anesthetic, which produced 6 weeks of pain relief with an onset 2 weeks after injection. Her next injection with Myobloc 5000 units (combined with local anesthetic) produced an increased duration of pain relief of 3 months. TW was a 55 year-old man with occipital neuralgia. His pain was intractable to oral agents and was injected with Myobloc 5000 units mixed with local anesthetic. His pain relief has lasted beyond 1.5 months. These 3 case reports demonstrate the potential use of BTs in treating occipital neuralgia. Additional clinical trials are warranted.

Perineuromal Stimulation in the Treatment of Occipital Neuralgia: a Case Study

This case study is presented to exemplify the application of a perineuromal approach in the treatment of recalcitrant occipital neuralgia. The patient was a 49-year-old female with severe and disabling occipital neuralgia. The pain persisted despite several surgical procedures, injections in the affected area, and medications. Threading the electrode into the cervical epidural space and attempts at peripheral stimulation using the Weiner and Reed approach were unsuccessful. Immediate benefit was derived when the electrode was advanced subcutaneously and positioned underneath the neuroma apparently created by a C2 nerve transection. A Medtronic Octad (model #3898) was utilized. The patient was contacted at seven and nine months post implantation. She reported 90% improvement in her pain. The improvements were also noted in numerical pain ratings, Beck Depression Inventory, and Oswestry Disability Scale. These improvements were corroborated by her husband. The Minnesota Multiphasic Personality Inventory (MMPI) remained relatively unchanged. This case illustrates the possible utilization of perineuromal stimulation in the treatment of occipital neuralgia. The specific mechanism of action remains unclear. Replication and controlled studies are required to determine the general applicability of this approach.

Treatment of occipital neuralgia by partial posterior rhizotomy at C1–3

To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. This resulted in satisfactory preservation of scalp sensation in all cases. Pain within the territory of the greater occipital nerve was consistently reduced or abolished by this procedure. The overall degree of pain relief was rated good or excellent after 10 of the 14 procedures. The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1-3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1-3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.