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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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.

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

11. 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.

12. 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

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

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

15. 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.

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

17. 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.

18. 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.

19. 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.]

20. 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.

21. 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.

22. Hope this helps!