The diagnosis of occipital neuralgia is done by:
1. Manifestations; pain, with or without persistent aching in the distribution of the greater, lesser, and/or third occipital nerve
2. Tenderness over the nerve
3. Pain is resolved or decreased by local anesthetic block of the nerve.
4. Ruling out other causes of headache.
The treatment steps are;
1) Conservative treatment;
a) posture correction
b) medications; tricyclic antidepressants, serotonin reuptake inhibitors, carbamazepine, oxycarbamazepine, gabapentin, pregabalin, and opioids.
c) Infliximab has shown some benefit,
d) Physical therapy.
2) Local anesthetic agent injection with steroid
3) Botulinum toxin infiltration
4) Pulsed radiofrequency (PRF) treatment.
5) Occipital nerve stimulation
7) Other surgeries; C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, and distal neurectomy.
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