Occipital Headaches (Occipital Neuralgia) Demonstration of a Technique to Unlock the Occipto-atlantal (O-A) joint By Jeffrey Pearson, D.O. www.medicine-in-motion.com

Occipital Headaches Type of headache that results from restriction/locking of one or both occipito-atlantal (O-A) joints. These are the two joints on the very top vertebra in the neck (the atlas) Imagine 2 “cups” on either side of the atlas. The base of the skull (occiput) rests balanced in them.

Occipital Headaches In the vicinity of the O-A joints lie the muscles of the suboccipital triangle and the greater occipital nerve. This nerve runs from the base of the skull, up and around the skull.

Occipital Headaches Awkward, static postures can cause one or both O-A joints to lock. Discomforts often NOT felt at the time. Symptoms generally develop over course of subsequent hours.

Occipital Headaches Most commonly present as unilateral (one-sided), throbbing headache often associated with nausea, dizzy/woozy sensations with movement. Often confused with migraine headaches.

Occipital Headaches Headaches need not be present to cause symptoms. May present with sudden dizziness or unexplained nausea Better term for this condition is occipital neuralgia Irritation of nerve may induce autonomic nervous system reflex symptoms E.g. hitting finger with hammer may be associated with nausea in addition to the pain.

Occipital Headaches Postures commonly associated with occipital neuralgia/headaches: Tucking telephone under chin Poor computer ergonomics Monitor too high/too low Watching TV while lying on couch Reading in bed Working above your head Trimming trees, painting, etc

Occipital Headaches May be acute Atraumatic (e.g. “Honey do’s”) Paint the ceiling Prune trees Fix the plumbing under the sink Head trauma Sports and motor vehicular injuries

Occipital Headaches Often chronic Chronic headaches are attributed to a variety of things including withdrawal from caffeine, pain relievers, etc. We are creatures of habit; hence we tend to perform similar tasks using similar postures on a repetitive basis over time. Receptionist using telephone without headset. Kids playing video games on the floor while looking up at television screen.

Occipital Headaches Treatment Acute Chronic ICE Unlock the joint (GENTLE mobilization) Pain relievers Naproxen sodium (Aleve), Tylenol, narcotics Chronic prevention

Occipital Headaches Do it yourself treatment options You must be very gentle! Any fast attempts will be met with reflex spasm, making mobilization difficult. Also want to avoid further injury.

Occipital Headaches 3 planes of motion Flexion/extension Sidebending Extension: gazing up at the ceiling Flexion: touching chin to chest Sidebending Touching ears to shoulders Rotation Turning head/neck to look over shoulder

Occipital Headaches 1. Palpate both O-A joints using index fingers

Occipital Headaches 2. Extend your neck backwards to gaze up at the ceiling.

Occipital Headaches 3. Sidebend to one side, then gently rotate your head to the opposite side It’s as if you were trying to look back and up at a star over your shoulder.

Occipital Headaches 4. Slowly work your way around towards the other side, monitoring the O-A joints all of the time.

Occipital Headaches If you’re REALLY gentle, you might be able to feel the restricted joint “unlock.” Then apply some ice and consider an over-the-counter anti-inflammatory/analgesic agent such as Aleve.

Occipital Headaches Alternative maneuver Lie supine (face up) with a towel roll supporting your neck (possibly with a cold gel pack) Slowly allow your neck to gently rotate from one side to another, back and forth. If you can relax enough, the joint might “unlock.” Follow-up with Aleve, as before.

Occipital Headaches Recurrences/chronic headaches Best treatment is prevention Look at daily postures both at home and at work. Fix poor ergonomics. Use telephone headsets; adjust computer monitors. Avoid awkward neck postures. [If you cannot, try to apply ice and perform some gentle range-of-motion stretching/exercises as soon as possible to prevent things from locking up.]

Occipital Headaches If you have symptoms of occipital neuralgia and they do not respond to these simple home maneuvers, contact your physician to verify diagnosis. If true migraine, should respond to a “triptan” type of medication. If elderly, stroke might need to be ruled out.

Occipital Headaches Sometimes, the joint(s) are so restricted that not even a physician/chiropractor can unlock it. Consider nerve block Inject local anesthetic (without a steroid) into the affected suboccipital triangle. Generally lasts 4-6 hours; patient goes home to rest and perform the previously described “alternative maneuver.” The hope is that the anesthetic will permit the local muscles to relax enough to finally unlock. “Good drugs” Muscle relaxants, analgesics (“pain killers”) such as Fioricet, hydrocodone. These might make subsequent attempts, later on in week, at mobilization easier.

Hope this helps!