Occipital Neuralgia: What It Is and How to Treat It

The doctor will want you to describe the pain and tell them how long the pain has been a problem. You’ll also need to tell them about any medications you take and any other medical issues you have. This is because neuralgia may be a symptom of another illness such as MS, diabetes, or lupus.

What You Need to Know About Neuralgia

Neuralgia is a type of pain caused by a nerve that’s irritated or damaged. Causes include shingles and underlying medical conditions such as multiple sclerosis. Treatment will vary depending on the cause.

Neuralgia is a stabbing, burning, and often severe pain due to a nerve that’s irritated or damaged.

The nerve may be located anywhere in the body. The damage may result from one of several causes, including:

• aging
• an infection such as shingles
• a chronic condition such as multiple sclerosis (MS) or diabetic neuropathy

Treatment for the pain depends on the cause.

Q:

What’s the difference between neuralgia and neuropathy?

A Healthline reader

A:

Neuralgia is a type of pain that’s caused by a nerve problem, and neuropathy is a type of nerve damage.

There are many causes of neuralgia, including nerve injury, pressure on the nerve, and neuropathy.

Neuropathy has many symptoms, including neuralgia, paresthesias (unusual sensations), and diminished sensation.

There are many causes of neuropathy such as inflammation, diabetes, chronic alcohol misuse, medications, infections, and more.

Heidi Moawad, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Neuralgia causes pain because of disruption of a nerve’s structure or function. This can happen for many reasons.

You may feel nerve pain from:

• damage or injury to a nerve
• pressure on a nerve
• changes in the way a nerve functions

The cause of your pain may also be unknown.

Infection

An infection, such as shingles, can affect your nerves.

Shingles is caused by the same virus as chickenpox. Your likelihood of having shingles increases with age.

An infection in a specific part of the body may also affect a nearby nerve. For example, if you have an infection in a tooth, it may affect the nerve and cause pain.

Pressure on nerves

Pressure or compression of nerves may cause neuralgia. The pressure may come from:

• a bone or ligament
• a blood vessel
• a tumor
• inflammation and edema (swelling)

MS

A material known as myelin covers the nerves. MS is caused by the deterioration of myelin.

MS sometimes affects the sensory areas of the spinal cord or brain, which can make these regions hypersensitive.

Diabetes

Many people with diabetes have issues with their nerves, including neuralgia and neuropathy (nerve damage).

The excess glucose in the bloodstream may damage nerves. This damage is most common in the fingers, hands, toes, and feet.

Diabetic neuropathy causes symptoms such as tingling or a “pins and needles” feeling.

Less common causes

Less common causes of neuralgia include:

• chronic kidney disease
• chronic inflammatory systemic diseases
• medications prescribed for cancer
• fluoroquinolone antibiotics, which are used to treat some infections
• trauma such as from an injury or surgery

There are multiple types of neuralgia. Neuralgia may be categorized by its cause or by the nerves it affects.

Trigeminal neuralgia

The trigeminal nerve is a type of sensory nerve. The branches of this nerve merge and then travel from the face to the brain.

Trigeminal neuralgia causes severe, recurrent pain in the face, usually on one side. It’s the most common type of neuralgia. Most people with trigeminal neuralgia are over 50 years old .

Common causes include dental work, a severe dental condition, and the pressure of a swollen blood vessel.

Other causes include:

• a blood vessel pressing down on the nerve where it meets with the brain stem
• nerve injury
• MS
• diabetes

Postherpetic neuralgia

Postherpetic neuralgia occurs as a complication of shingles and may affect any part of the body.

Shingles is a viral infection characterized by blisters and a painful red rash. This rash usually appears on the back or abdomen, but it may also show up on the neck or face.

Neuralgia can occur wherever the outbreak of shingles occurred.

The pain can be mild or severe and intermittent or persistent. It can also last for months or years.

Because the pain always occurs along the path of a nerve, it’s usually isolated to one side of the body.

Glossopharyngeal neuralgia

Pain from the glossopharyngeal nerve, which is located in the throat, isn’t very common. This type of neuralgia produces pain in the neck and throat.

Occipital neuralgia

Occipital neuralgia is another rare type of neuralgia. The occipital nerves are located in the scalp. As a result, occipital neuralgia causes a type of headache pain.

Intercostal neuralgia

Intercostal neuralgia affects the intercostal nerves, which run through the chest, rib cage, and abdomen.

Neuralgia pain is usually severe and sometimes debilitating. If you have it, see a doctor or healthcare professional as soon as possible. If you don’t already have a healthcare professional, our Healthline FindCare tool can help you connect with physicians in your area.

Also, see a doctor if you suspect you have shingles. Shingles should be treated as soon as possible to prevent complications. Postherpetic neuralgia can cause debilitating and lifelong pain.

When you see a doctor about neuralgia, you can expect to be asked a series of questions about your symptoms.

The doctor will want you to describe the pain and tell them how long the pain has been a problem. You’ll also need to tell them about any medications you take and any other medical issues you have. This is because neuralgia may be a symptom of another illness such as MS, diabetes, or lupus.

The doctor will also perform a physical exam to pinpoint the location of the pain and the nerve that’s causing it, if possible.

You may also need to have a dental exam. For example, if the pain is in your face, the doctor may want to rule out other possible dental causes such as an abscess.

In addition, to help find an underlying cause of your pain, the doctor may order certain tests such as:

• Blood tests: A healthcare professional may perform a blood draw to check your blood sugar levels and kidney function.
• MRI: An MRI can help a doctor determine if you have MS.
• Nerve conduction velocity test: The nerve conduction velocity test can help a doctor determine the extent of your nerve damage. It shows how fast signals are moving through your nerves.

If the doctor can pinpoint the cause of your neuralgia, your treatment will focus on treating that underlying cause. If they can’t identify the cause, treatment will instead focus on relieving your pain.

Potential treatments may include:

• better blood sugar management, which might help slow the progression of diabetic neuropathy
• physical therapy
• a nerve block, which is an injection directed at a particular nerve or nerve group that’s intended to “turn off” pain signals and reduce inflammation
• medications to relieve the pain
• surgery to relieve pressure on the nerve

Medications that they may prescribe include:

• capsaicin, which is available as a cream or patch
• antidepressants such as amitriptyline or nortriptyline (Pamelor), which are effective in treating nerve pain
• antiseizure medications such as carbamazepine (Epitol, Tegretol), which are effective against trigeminal neuralgia

The Food and Drug Administration (FDA) has approved the use of Epitol and Tegretol for people with trigeminal neuralgia. However, most antidepressants and antiseizure medications are used off label for neuralgia.

Off-label drug use

Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat people.

So, a doctor can prescribe a drug however they think is best for your care.

Neuralgia can be uncomfortable and even debilitating, but it’s not life threatening.

There’s no cure for it at the moment, but various treatments are available to help improve your pain. More research is being performed to identify even more treatments, with a recent literature review touting botulinum toxin as a promising remedy.

Last medically reviewed on January 5, 2023

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Deng Y, et al. (2016). Clinical practice guidelines for the management of neuropathic pain: A systematic review.
  bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-015-0150-5
• Diabetic neuropathy. (2018).
  niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/all-content
• Fazekas D, et al. (2022). Intercostal neuralgia.
  statpearls.com/ArticleLibrary/viewarticle/23594
• FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. (2018).
  fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-advises-restricting-fluoroquinolone-antibiotic-use-certain
• Glossopharyngeal neuralgia. (2022).
  ninds.nih.gov/health-information/disorders/glossopharyngeal-neuralgia
• Kayani AMA, et al. (2022). Therapeutic efficacy of botulinum toxin in trigeminal neuralgia.
  cureus.com/articles/104847-therapeutic-efficacy-of-botulinum-toxin-in-trigeminal-neuralgia
• Nerve blocks. (2022).
  radiologyinfo.org/en/info/nerveblock
• Peripheral neuropathy. (n.d.).
  cancer.org/treatment/treatments-and-side-effects/physical-side-effects/nervous-system/peripheral-neuropathy.html
• Pilitsis JG, et al. (n.d.). Occipital neuralgia.
  aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Occipital-Neuralgia
• Shingles (herpes zoster). (2022).
  cdc.gov/shingles/index.html
• Trigeminal neuralgia fact sheet. (2022).
  ninds.nih.gov/trigeminal-neuralgia-fact-sheet

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Occipital Neuralgia: What It Is and How to Treat It

Occipital neuralgia is a painful condition that occurs when the occipital nerves that run from the top of your spine to your scalp are compressed or irritated.

Occipital neuralgia is a painful condition that causes neck pain and is often accompanied by a headache. Read What Is Causing My Neck Pain and Headache?

Occipital neuralgia symptoms and causes

If you have occipital neuralgia, you may experience one or more of these symptoms:

• Throbbing, aching pain or sharp, electric-like pain that typically starts where the back of your head meets your neck.
• Pain that radiates to one side of your head, down your neck and/or back.
• Pain behind your eye.
• Increased sensitivity of your scalp.

These symptoms can be caused by irritation of the occipital nerves along their path, which may occur:

• Spontaneously, as a result of a pinched nerve root in your neck due to an injury or surgery. Commonly the roots of C2 and/or C3 at the top of your cervical spine are affected. See The C1-C2 Vertebrae and Spinal Segment
• Due to irritation/compression from tight neck muscles. This muscle tightness may be associated with physical or emotional stress.

The exact cause of occipital neuralgia may not always be determined. You may experience migraines or tension headaches simultaneously with occipital neuralgia.

Finding occipital neuralgia pain relief

Here’s how you can ease painful occipital neuralgia symptoms:

• Apply ice/heat therapy. Ice therapy may reduce local inflammation and relieve pain. Tuck an ice pack under the base of your skull as you lie down. However, you may find more relief using heat therapy, such as an electric heating pad. When you apply heat to the affected area, local blood vessels are dilated and blood flow to the neck increases, which can reduce muscle tightness. Don’t apply the cold/heat source for more than 20 minutes at a time. Always use a barrier, such as a hand towel, between your skin and the cold/heat source. See How to Apply Heat Therapy
• Take NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAID) are over-the-counter medications such as ibuprofen (e.g., Advil, Motrin) and naproxen (e.g., Aleve). Taking them may help reduce inflammation and relieve headache/neck pain. Follow the instructions on the labels and discuss with a physician or pharmacist to make sure you’re using these medications safely. See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs
• Give yourself a neck massage. Apply gentle pressure from your fingertips at the base of your skull. This massage can help calm tight muscles and release tension. You can also place a rolled towel under your head and neck as you lie down on your back. The pressure from the towel can provide a gentle massage. Stop immediately if the massage aggravates your pain. See Massage Therapy for Chronic Stiff Neck

• Do chin tucks regularly. Some cases of occipital neuralgia may be related to poor posture stressing the nerves. The chin tuck exercise aims to stretch the muscles and connective tissue in the painful area and strengthen the muscles that align your head over your shoulders. Stand with your upper back against a wall, feet shoulder-width apart. Face forward, tuck your chin down, and pull your head back until it meets the wall. Try to bring your head back in a straight line without tilting it back or nodding forward. Hold the stretch for 5 seconds before resting, and repeat 10 times. If this exercise increases pain or discomfort, stop immediately. See Easy Chin Tucks for Neck Pain

If these self-care tips don’t ease your occipital neuralgia pain, visit a health care provider. You may find relief through prescribed pain medications and/or a guided physical therapy program. A doctor may even consider offering a steroid injection to help relieve inflammation and reduce the pain.