If you suffer from severe head or facial pain, you may want to learn more about trigeminal and occipital neuralgia. Neuralgia is nerve-related pain, and trigeminal and occipital neuralgia are two of the most potentially-debilitating types. Trigeminal neuralgia and occipital neuralgia affect different areas of the head. Both can produce symptoms ranging in severity from minor twinges to migraines so bad that they induce vomiting. There are several similarities between the two conditions, such as methods of treatment, but the key difference between the two is which nerve is affected.
The differences between trigeminal and occipital neuralgia
Trigeminal and occipital neuralgia are similar, but there are differences. Trigeminal neuralgia is nerve pain related to the trigeminal nerve. This type of neuralgia is caused by damage, inflammation, or irritation of the trigeminal nerve. In occipital neuralgia, on the other hand, it’s the occipital nerve that’s affected.
There is one trigeminal nerve on each side of the face, and each nerve splits into three branches. It provides sensory innervation to the face and motor innervation to the muscles that are used for chewing and swallowing.
- The first branch is the ophthalmic nerve (V1), which covers the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose, and frontal sinuses.
- The second branch is the maxillary nerve (V2), which covers the lower eyelid, cheek, upper lip, teeth, and gums, the nasal mucosa, the palate, part of the pharynx, the maxillary, ethmoid and sphenoid sinuses.
- The third branch is the mandibular nerve (V3), which covers the lower lip, teeth, and gums, the floor of the mouth, the anterior ? of the tongue, the chin, the jaw, and parts of the external ear. The mandibular branch is the nerve that also provides the motor function.
- All three branches supply parts of the meninges
Pain from trigeminal neuralgia can be occasional twinges, regular episodes of severe pain, constant pain, or volleys of painful attacks that come and go regularly for days or weeks at a time. Activities like eating, talking, or even feeling a breeze on the cheek can sometimes trigger an attack.
Trigeminal neuralgia pain may be limited to the area affected by one branch of the trigeminal nerve. The pain is usually limited to one side of the face, but in some rare cases there might be pain on both sides of the face. In extremely rare cases, pain may be felt at the same time on both sides of the face.
In occipital neuralgia, it’s the occipital nerve that’s affected.
The occipital nerve runs from the top of the spinal cord up the neck and up the scalp. When the occipital nerve is damaged, inflamed, or irritated, an individual might experience pain that begins at the back of the head and radiates forward.
Pain behind the eye, a tender scalp, sensitivity to light, or pain when moving the neck might also occur. Because there are two occipital nerves running up from the neck over the scalp, it’s possible to only experience pain on one side of the head at a time.
Washing the hair or lying on a pillow might become very difficult. Additionally, the pain associated with occipital neuralgia can be similar to other head pain conditions, so it’s easy for an occipital headache or occipital migraine to be mistaken for something else and go undiagnosed.
You can learn more about occipital neuralgia in the video below.
Conditions related to trigeminal and occipital neuralgia
There are certain conditions that are commonly associated with neuralgia, although the type is not limited to only occipital neuralgia and trigeminal neuralgia.
A few of these conditions include:
- Multiple sclerosis
- Some infections, such as AIDS or shingles
- Chronic renal insufficiency
- Certain medications
Occipital and trigeminal neuralgia causes
As for trigeminal and occipital neuralgia specifically, there are very few risk factors. More women develop these types of neuralgia than men. The risk of trigeminal neuralgia also increases for those over 50 years of age.
Compression of the nerve root is the recognized cause of trigeminal and occipital neuralgia most of the time. 80-90% of the time it is the abnormal loop of an intercranial artery, or less commonly, vein, that compresses the nerve root close to the location where it enters the brain stem. As a result, the nerve acts in an erratic manner, causing pain signals to be sent sporadically at the trigger of light touch, chewing, or brushing the teeth.
Rarely, traumatic injuries of the nerve, such as a car accident, can lead to similar damage. In multiple sclerosis, loss of myelin in one or more of the trigeminal nerve nuclei can also cause trigeminal and occipital neuralgia. Other more rare causes of compression are tumors, epidermoid cyst, or aneurysm. The compression then leads to damage of the protective covering of the nerve, called myelin.
Treatments for occipital neuralgia and trigeminal neuralgia
Many treatments focus on pain management, although there are surgical treatments that can possibly provide more lasting relief.
If the pain from trigeminal or occipital neuralgia isn’t too severe, it might be worth trying some home therapies to find relief. Rest in a quiet room, a neck massage, or the application of heat might help. Over-the-counter pain medications, like Advil or Tylenol, might also alleviate symptoms.
Controlling facial pain with current medical and surgical treatments is known to be very difficult, but may be helpful for people who don’t respond to more conservative treatments. The standard medical approaches are anti-inflammatory, anticonvulsant, and antidepressant medications. After these fail, local anesthetic blocks are attempted, but only provide temporary pain relief. Lastly, percutaneous or open procedures may be done, or even more rarely, neurostimulation. However, peripheral nerve stimulation may be a viable option earlier in the treatment of chronic facial pain.
Medications for occipital and trigeminal neuralgia
Medical treatment is usually the first-line therapy. Carbamazepine is the most effective and usually has manageable side effects. If it is ineffective or not tolerated, then combination with gabapentin, phenytoin, baclofen, lamotrigine, topiramate, or tizanidine may be beneficial.
It is recommended to periodically taper the medications down in patients experiencing pain relief in order to check for the occasional permanent remission.
Interventional pain management
Radiofrequency ablation has a fairly high rate of success in treating different types of neuralgia. This procedure includes cauterizing painful nerves to cut off pain signals. The nerve will most likely heal eventually, which usually means the return of trigeminal or occipital neuralgia pain. However, if successful, the procedure can be repeated.
Injected medications might find success at pain alleviation, too. Nerve block injections typically contain an anesthetic like lidocaine. Some include a steroid, as well, to reduce inflammation. These injections are delivered directly to the affected nerve. Patients who receive nerve block injections often feel relief very quickly. Nerve block injections are also very useful in diagnoses.
Alternative therapies are also helpful at times. Acupuncture is the strategic insertion of thin, sanitized needles to provide pain relief. Chiropractic care can be effective at times, although it’s always a good idea to discuss alternative treatments with a physician before pursuing them.
Another potential alternative treatment is a Botox injection. These injections are most commonly known for their cosmetic uses, because Botox is actually a paralytic toxin. This can be useful for getting rid of facial wrinkles, but it can also block impulses sent along nerves, thereby blocking the pain signals.
Surgery for occipital and trigeminal neuralgia
More extreme treatments, such as surgical treatments, carry higher risks, so it’s important to have a solid diagnosis before pursuing a surgical procedure. If, for example, a nerve block injection applied to the occipital nerve provides pain relief, then a surgical procedure focusing on the occipital nerve has a good chance of providing pain relief.
If other options haven’t worked, there are several options for surgical procedures. These surgeries include:
- Microvascular decompression: An invasive procedure involving removal or separation of vasculature, which is often the superior cerebellar artery, away from the nerve.
- Balloon compression: A balloon catheter is inflated and used to compress the ganglion.
- Gamma knife radiosurgery: A noninvasive treatment that creates lesions by using focused gamma radiation. The radiation is targeted at the proximal nerve root with the aid of stereotactic frame and MRI.
- Linear accelerator radiosurgery: A noninvasive approach similar to gamma knife, but uses a different form of radiation, linear acceleration.
- Peripheral neurectomy: An incision, radiofrequency lesioning, alcohol injection, or cryotherapy is used on a peripheral branch of the nerve.
- Chemical rhizotomy: An injection of glycerol into the trigeminal cistern. Tingling or burning is felt in the face, and pain relief is usually immediate, but may take up to a week.
Surgeries to treat trigeminal or occipital neuralgia are the most high-risk treatment options, but they can potentially give longer-lasting relief if nothing else has worked.
Living with trigeminal and occipital neuralgia
If you’re suffering from pain that may be occipital neuralgia or trigeminal neuralgia, a pain doctor can help you get a diagnosis and find treatment options that work for you. If conservative or at-home treatments haven’t helped manage your pain, click the button below to talk to a pain doctor in your area.