1. Occipital Neuralgia and Nerve Blocks

2. Learning Objectives
Have an understanding of what is Occipital Neuralgia (ON)
Have an understanding of how to treat ON
Have an understanding of what each part of the ON treatment does
Have an understanding of why all treatment steps must be done to cure the ON

3. What is Occipital Neuralgia?
Greater
Occipital nerves
Occipital neuralgia is a type of chronic headache disorder. It occurs when pain stems from the occipital region and spread through the occipital nerves. The occipital nerves run from the top of you spinal cord to your scalp.
Trapezius muscle

4. The occipital nerves can become pinched and irritated from the trapezius muscle being tight and spasming.
When the nerve gets pinched it is unable to send proper signals and will send signals into the muscle causing the muscle to spasm and pinch the nerve more

5. Painful Areas Center of Vortex
Hot spots of pain due to greater occipital nerve
Supraorbital
Temporal
Tempero-mandibular
Angle of jaw
Sternocleidomastoid
Supraclavicular

6. Staying hydrated allows the body to function appropriately
Increasing foods that are anti-inflammatory such as fish, grapes, olive oils, and cherries helps reduce systemic inflammation and reduce pain; for more help on this ask to meet with our dietician
B Vitamins, Magnesium and CoQ10 help relieve ON by boosting the body’s ability to heal itself. Vitamin B12 aides normal nervous system development and nerve regeneration
Start with your Diet
Caffeine
Processed food and sugary foods increase systemic inflammation, leading to nerve irritation
Caffeine is a diuretic and a vasoconstrictor

7. Neck Stretches Repeat: three times Complete: two sets
Hold: 20 Seconds Perform: three times per day
Cervical Flexion
Tilt your head downwards, then return back to looking straight ahead
Cervical Rotation
Turn your head towards the side, then return back to looking straight ahead
Levator Scapulae Stretch
Place the arm on the affected side behind your back and use your other hand to draw your head downwards towards the opposite side. You should be looking towards your opposite pocket of the affected side
Cervical Extension
Tilt your head upwards, then return back to looking straight ahead
Cervical Side Bend
Tilt your head towards the side, then return back to looking straight ahead. (Be sure to keep your eyes and nose pointed straight ahead the entire time
Upper Trap Stretch
Begin by retracting your head back into a chin tuck position. Next, place one hand behind your back and gently draw your head towards the opposite side with the help of your other arm.

8. Get a Deep Tissue Massage
Getting a deep tissue massage breaks the large muscle group fibers down, and helps relieve the tension that may be causing the occipital nerve to be irritated and pinched.
Massage the neck down.
AVOID THE OCCIPITAL NERVES!
Pushing on the occipital nerve will cause irritation and then a headache.
Do not massage above this line!

9. Consider how you are sleeping
Too little sleep can exacerbate pain the following day, which can cause sleep issues the next night.
Occipital neuralgia is caused by pinched nerves, by adjusting the position you sleep in can reduce the pain. Placing your neck in a crooked position can cause your neck and head muscles to spasm and contract. The position will also apply pressure to the occipital nerve. Use a gel pillow that supports your neck but wont allow your head to be higher than your neck.

10. Lidocaine can be injected into the internal capsule, numbing the nerve and the muscle to help break the negative feed back loop
A set of three nerve blocks is typically needed for full effect
Greater Occipital nerve
Nerve Block
Lesser Occipital Nerve
Trapezius muscle

11. Questions? Call 775-501-8911 or ask us at your next appointment
Please take a moment to complete the assessment and evaluate what you learned

12. Annotated Bibliography
Narouze, (2016) researched nerve pain involving the pain distribution of the greater, lesser and third occipital nerves. He researched patient who did not respond well to conservative treatments such as diet, neck stretches, sleep, and massage. By using ultrasound he identified and located areas of the occipital nerve that was entrapped and injected lidocaine into the location to relax the nerve and muscle, resulting in good effects for the patients.
Dougherty (2014) wrote a research article on occipital neuralgia on the different techniques and treatments for Occipital Neuralgia. He found that with conservative treatment, occipital nerve blocks and occasionally muscle relaxants, antidepressants and/or antiepileptics that patient could become free from the chronic headache disorder.
References
Dougherty, C. (2014). Occipital Neuralgia (18: 411). Retrieved from SpringerLink:
Narouze, S. (2016). Occipital Neuralgia Diagnosis and Treatment ( doi: /head Epub 2016 Mar 21.). Retrieved from PubMed: