Migraine sufferers know very well that the onset of a headache can bring with it a sense of panic. Those diagnosed with migraines often have to learn their triggers, carefully manage their environments and have a backup plan for handling life’s duties when a migraine comes calling. If a migraine reaches its peak, a person may be disabled for 3 to 4 days at a time. The intense pain of a migraine can make it difficult to be anywhere but a dimly lit room. The pain can localize at the temples or behind the eye may make it difficult to do anything but lie down in a quiet space. You may be far more familiar with the symptoms of migraine headaches than you’d like to be. If you’ve received a migraine diagnosis and have been prescribed medication for your headaches, you understandably expect your treatment to work. What if it doesn’t? It’s not unheard of for migraine medication to fail to relieve pain. When migraine medication doesn’t work, a pain specialist may question the diagnosis. What may really be causing migraine pain is occipital neuralgia. If that is the case, the treatment protocol would be entirely different.
Occipital Neuralgia or Migraine? Migraines are triggered by changes in the brain. Doctors used to believe that the pain was caused by a change in blood flow in the brain. Through research, the origin of migraine pain has been identified as a trigger to the trigeminal nerve. The stimulated nerve causes the release of chemicals in the brain that result in inflammation. In contrast, occipital neuralgia originates with irritation or compression of the nerves that travel from the neck up the back of the head. Nerve entrapment may occur due to trauma like whiplash or to muscle spasms in the neck or head. In some cases, doctors cannot find the cause of the nerve irritation.
A person experiencing a migraine may complain of one-sided pain or bilateral pain. The head may ache or throb. Burning sensations may even occur from the base of the head up the back of the scalp. Pain at the back of the neck and head can be sharp and piercing or feel like small electrical shocks. The scalp may feel tender and it may feel difficult to move the head. Here’s what’s interesting. These symptoms may also be the result of occipital neuralgia. For this reason, it is possible that a person with the latter may be misdiagnosed with the former. If migraine medication isn’t working, it may be beneficial to explore the potential that pain is originating in an unexpected area.
A pain management specialist performs a thorough and very specific process to determine if what seems like migraine pain may actually be occipital neuralgia. The doctor first conducts a comprehensive medical history and review of symptoms. One indicator that occipital neuralgia may be at play is that pain begins in the neck and travels up the head, often to the eyebrow area. After receiving the patient’s history, the doctor performs an exam. Primarily, this involves palpating the nerves at the base of the skull. To “test” the nerves, the doctor may perform a nerve block. This minor injection of lidocaine or another medication numbs the greater and lesser occipital nerves. Numbed, the nerves cannot send pain signals to the brain. In addition to the nerve block, the doctor may also inject steroid medication in the area of the irritated nerve to soothe inflammation that contributes to pain.
The occipital nerve block can be used diagnostically to determine the true cause of head pain. If the nerve block works to alleviate pain or prevent it, the nerve block may then be used therapeutically as needed to manage chronic headaches. A nerve block may last from several weeks to several months. In some cases, a person’s pain never recurs after this treatment.
Have you wondered why your migraine medication doesn’t help? Perhaps your headaches aren’t what they seem. Learn more about occipital neuralgia and occipital nerve block treatment from Dr. Anil Chenthitta. Dr. Chenthitta is a board-certified and fellowship-trained physician with extensive experience treating chronic and acute pain. To schedule a consultation at our Lansdowne facility, contact us at 571-510-3815.