When Your Head Hurts: Trigeminal And Occipital Neuralgia

//When Your Head Hurts: Trigeminal And Occipital Neuralgia

When Your Head Hurts: Trigeminal And Occipital Neuralgia

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.

Trigeminal neuralgia

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

When Your Head Hurts: Trigeminal Neuralgia | PainDoctor.com

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.

Occipital neuralgia

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
  • Fibromyalgia
  • Porphyria
  • 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.

When Your Head Hurts: Trigeminal And Occipital Neuralgia | PainDoctor.com

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.

When Your Head Hurts: Trigeminal And Occipital Neuralgia | PainDoctor.com

Complementary therapies

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.

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By | 2016-12-09T12:57:18-07:00 November 30th, 2016|Tags: , , , , , |30 Comments

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  1. Avatar
    David DeRosia April 24, 2017 at 11:54 pm

    How often do you encounter patients with symptoms of both Trigeminal and Occipital Neuralgia? I started with what I thought was a bad tooth (left mandibular excruciating pain) but the dentist debunked that. The pain was episodic and varied from lasting seconds to minutes to 1-2 hours and varied in intensity. The pain wasn’t limited to my left mandible, but that is where it remains the most severe (like a hot poker). Other areas of pain include the side of my face/forehead/maxillary area. My doctor started me on Neurontin, which helped for a short time but I quickly maxed out on that with frequent break through pain. Next was Lyrica, which seemed to help for about a week or so and went the same way as the Neurontin. Around this time I started noticing pain that started in my left occipital area and spread anterioraly. Sometimes it is concurrent with the mandibular pain and other times it is independent of it. It is less severe than the mandibular pain but persists from minutes to several hours at a time and is debilitating, making it difficult to think or do normal daily life. It hurts to touch the side of my head or to even lay my head on a pillow. Last week my doctor changed me to Tegretol XR. For 4 days I didn’t have the excruciating pain in the mandibular area….thank god! I did have more of the occipital and lateral head pain however, since starting the Tegretol. The mandibular pain returned yesterday morning for a 90 minute visit and again last evening for a shorter time as well. I had an MRI done which didn’t show any mass and I’m waiting for a neurologist appointment in 10 days. I’ve been an Emergency Nurse for 24 yrs and I am the Charge Nurse supervising up to 14 staff members and coordinating flow of patients into and out of a community hospital as well as providing direct emergency nursing care to any and all patients that present there for care. I can’t think straight when the pain is present. I don’t know if it will last for seconds or minutes or hours. How likely is it that I can have sxs of both Trigeminal and Occipital Neuralgia at the same time? Is there a greater likelihood that I could have some sort of aneurysm that wouldn’t show up on an MRI? My sister and other family members have MS as well, but I would think that the MRI would show demyelination. Any thoughts or suggestions you might have would be greatly appreciated. Thank you for your time.

    • Pain Doctor
      Pain Doctor May 2, 2017 at 12:46 pm

      Hi David — Thank you so much for sharing your story and asking these really great questions here. Unfortunately, we do have to be limited in answering questions about specific medical conditions and treatments online. This is mostly to protect you, as we can’t fully explain something without knowing your full case history. Because of that, we recommend finding a pain specialist in your area to discuss these questions. You can set up a consult appointment to ask these questions and learn more about treatments that could work for you. You can find a doctor in your area here: https://paindoctor.com/find-your-pain-doctor/

      We hope that helps!

  2. Avatar
    Sherry August 7, 2017 at 5:12 am

    I have a 20 yr old daughter with chronic head and face pain. Took her to an ENT who diagnosed her with TMD and sent us to a dentist who specializes in it. Dentist confirmed it made a night guard but it really doesn’t help much. She has also been to a rheumatologist with a unconfirmed case of possibly some autoimmune disease but nothing came about from that. Then took her to an clinic that treats you based on vitamin deficiency and she did find some relief for a short period of time. So I don’t know what else to pursue, what kind of Dr she needs to see. Could it be MS, or fibromyalgia or any of the conditions you talk about in this article? I would appreciate any input you could give me. Thank you

    • Pain Doctor
      Pain Doctor August 8, 2017 at 9:58 am

      Hi Sherry — We’re so sorry to hear how your daughter is suffering. Unfortunately we can’t speculate on diagnoses online without an in-person exam. We recommend visiting a pain specialist next. It looks like you’ve tried a lot of different resources, which was smart of you to pursue. A pain specialist will be able to take that information, run a more specialized series of tests, and help her find out what’s causing her pain. There are a lot of causes of chronic head and face pain, and a great doctor won’t stop until they’ve figured out the right diagnosis and treatment plan for her.

      You can search for a doctor near you in our tool: https://paindoctor.com/find-your-pain-doctor/. If one of our doctors isn’t in your area, we provide tips for finding great doctors near you at https://paindoctor.com/pain-management-doctors/. Hope that helps!

  3. Avatar
    Sherry August 8, 2017 at 6:49 am

    I left a comment yesterday and now it’s gone and was not answered. Also subscribed to email and nothing there either.

    • Pain Doctor
      Pain Doctor August 8, 2017 at 9:55 am

      Hi Sherri — We have to approve all comments before they’re posted to the site to cut down on spam. Your post is now above with a response. Newsletters go out on days when new posts go up — typically Mondays and Wednesdays. Thanks for checking and for subscribing!

  4. Avatar
    Sherry August 10, 2017 at 8:23 pm

    Thank you for replying and we will continue to seek the answer. Sorry about being impatient. Keep up the good work and God bless. 🙂

    • Pain Doctor
      Pain Doctor August 14, 2017 at 2:52 pm

      No worries! It’s hard when you’re trying to help a loved one who is in pain. Sending good thoughts your way.

  5. Avatar
    Cindy August 19, 2017 at 4:07 pm

    Can trigeminal neuralgia have pain from forehead all the way to crown of my head. Once in a while it sparks from forehead to side of nose but most pain is in the forehead up into the scalp. Oxycarbanzipine does dull the sparking but makes me so sleepy. Tried to take smaller doses throughout the day and full doses at night. This has gone on for over a year. Is this normal?

    • Pain Doctor
      Pain Doctor August 20, 2017 at 5:17 pm

      Hi Cindy — Unfortunately we can’t offer specific medical advice online. However, we do recommend reaching out to a pain specialist in your area who can help you find relief and answer any questions you have: https://paindoctor.com/find-your-pain-doctor/.

  6. Avatar
    Sarah September 12, 2017 at 7:33 am

    What are the odds of having both occipital neuralgia and trigeminal neuralgia?

    • Pain Doctor
      Pain Doctor September 18, 2017 at 6:48 pm

      Hi Sarah — Unfortunately we can’t answer specific medical questions on the blog. We recommend reaching out to a pain specialist near you for more information: https://paindoctor.com/get-relief-now/.

  7. Avatar
    Michele Rossi Gildea November 9, 2017 at 2:37 pm

    Hi– m 91 year old father has had textbook occipital neuralgia symptoms for three weeks. He has been in terrible pain– especially on one side of his head, had pressure feeling behind that eye and little “lightening bolts” in that side of his face, his hair and scalp hurt to the touch. SIMULTANEOUSLY he got what looked at first like bites on the back of his head and then around ear. Then they looked like scabbed over blisters– I was gently washing with T-Gel thinking it was a skin problem.

    1. Trip to PCP– agreed with my layman’s occipital neuralgia dx, and did nothing until I demanded at least a muscle relaxant which seemed to help a bit.
    2. Today we went to his dermatologist who took one look at his head and said “shingles.” So no he is on steroids and valtrex– I had him stop the muscle relaxers.

    Question: Of course I understand that he may be unlucky enough to have BOTH conditions– but is it possible that the nerve pain could be related to the shingles? I am so upset for him, he is miserable. Thank you.

    Question– could what seems

    • Avatar
      Jennifer Bennett July 5, 2018 at 1:01 pm

      I have been diagnosed with post herpetic trigeminal neuralgia in all three branches on my right side. I had shingles two years earlier and when my pain started I went to the doctor and told her it felt like shingles, but there was no rash. I couldn’t wear my glasses, brush my teeth or hair and my throat felt like I swallowed broken glass. I wanted to scoop my eyeball out with a spoon to stop the pain. I went to the dentist and begged him to pull my back teeth.
      Luckily I was diagnosed fairly early on. I discovered my triggers (mine were cold air, cold drinks, heavy vibrations, cold sores) and I can avoid the most severe attacks for the moment with medication and avoiding triggers. I wish you and your father good luck and good health.

  8. Avatar
    Michele Rossi Gildea November 9, 2017 at 2:39 pm

    oops– what seems like occipital neuralgia be nerve pain related to shingles?

  9. Avatar
    Carole February 16, 2018 at 7:05 pm

    So glad I found this sight. My husband suffering with this neuralgia right now. I hope he will see a pain doc as he seems to suffer with this more often.

  10. Avatar
    Maddie April 28, 2018 at 5:30 pm

    acupuncture works for both trigeminal and occipital neuralgia. try it.

    • Pain Doctor
      Pain Doctor May 7, 2018 at 4:25 pm

      Thanks for sharing your suggestion!

  11. Avatar
    Maddie April 28, 2018 at 5:37 pm

    I have both trigeminal and occipital neuralgia. It started several years ago and I was waking up every night with a horrible pain across my forehead and down the side (left) of my face. I had a cat scan – no tumors – and was put on 100mg of gabapentin daily. I helped but I didn’t want to continue taking it so I stopped. I started acupuncture and it finally went totally away for almost a year and a half. It is now back withy a vengeance and I am not able to put my head on a pillow because it will start and this time it last at least an hour it not longer. I just started acupuncture again and have gone three times and nothing yet. I’m hoping this will work. I’m also checking in on homeopathic remedies for this condition rather than taking drugs which is a cover up. I suggest everyone try acupuncture and natural remedies.

    • Pain Doctor
      Pain Doctor May 7, 2018 at 4:25 pm

      Hi Maddie, thank you for sharing your story here and we are so sorry to hear about the challenges you’ve faced with this condition.

  12. Avatar
    Tamra May 8, 2018 at 5:01 pm

    I was diagnosed with Occipital Neuralgia last week, but today, along with the severe shooting headaches at the back and top of my head, I have pan washing my hair and drying it and having my head touch a pillow t the base and side on th elect.
    i started having behind the eye issues and now numbness on my lips.
    Is it possible to have both Occipital and trimengal at the same time?
    They put me on Carbamazepine 200mg at night, but hardly helps and pain when trying to sleep.
    I’m already on Gabalentin. And that helps a bit, but my sleep has an average of 3 hrs a night.
    I can feel the pain even while asleep. I’m waiting for my doctor to call me back. They said last Tuesday that I was being referred to a Neurologist for this and they will start with a Botox injection. Will that work formtheses symptoms? Thanks you, Tami T

  13. Avatar
    Stacie Pearson July 1, 2018 at 11:54 am

    Recently diagnosed with occipital neuralgia after exhausting migraine diagnosis. Exhausted OTC and prescription medications due to Gastrectomy with Roux-en-Y twerp years ago.. current treatments are local trigger point injections every 3 weeks with alternating cortisone steroid and Lidocaine with only 40% relief for 10 days. I am extremely interested in surgical intervention and recently approved for Botox treatment.
    ANY help would be greatly appreciated,

  14. Avatar
    Colleen Davison November 16, 2018 at 8:07 pm

    I just wanted to say what happened to me to see if anyone else has had these symptoms. It seems like it happened overnight, but I woke up one morning and my neck hurt really bad when I turned it , and I felt like there was something wrong with my right eye.I also had really loud ringing in my ears. I went to my eye doctor and he couldn’t dilate my right eye. My lens and cornea were stuck together, and he said there was only 2 small openings and if they closed up the pressure in my eye would go way up and I could lose my eyesight. So he sent me to an optimologist who couldn’t dilate my eye either, so I was scheduled for cataract surgery. Well waiting for my surgery I tried to figure out what was wrong with my neck, the extreme pain, high blood pressure, and ringing in my ears. I had an MRI, 3 complete x rays, ultrasound, 2 CT scans, and tens therapy. No one could figure out what was wrong until I finally found a doctor that actually listened to me. He did some movements with my neck and head, and he diagnosed me with cervico occipital neuralgia.It totally fit everything together that had been happening to me, and now I am scheduled for a nerve block. I had my eye surgery, and the lens was stuck so bad that after the surgery I was blind in that eye fir 1 and 1/2 days. It is better now, but I know it won’t be totally fixed until I get my pinched nerve fixed. This condition can affect many parts of your head, and it is so important to get the right diagnosis.

    • Pain Doctor
      Pain Doctor November 18, 2018 at 1:24 pm

      Thank you for sharing your story Colleen!

  15. Avatar
    Ryan November 19, 2018 at 4:12 pm

    Could an acupuncturist cause occipital nerve damage or trigeminal nerve damage? Reason I ask is I saw an acupuncturist and within a day began experiencing headaches and facial tingling on the left side of my face. He inserted a push pin between my eyes, a needle at the top of my head and one towards the back of my neck. It’s been 6 weeks now and I’m still having headaches following Dr. Stolmans treatment. What are your thoughts? Could he have aggravated or damaged a nerve? If so odds of it healing on its own?

    • Pain Doctor
      Pain Doctor November 25, 2018 at 10:55 am

      Hi Ryan — Unfortunately we can’t answer specific medical questions online. However, we do recommend reaching out to a pain specialist in your area who can help you find relief and answer any questions you have: https://paindoctor.com/find-your-pain-doctor/.

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