OCCIPITAL NEURALGIA AND HEADACHE - Health Plan of Nevada

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BACKGROUND
Cervicogenic headache and occipital neuralgia are conditions whose diagnosis and treatment have been
gradually refined over the last several years. This terminology has come to refer to specific types of
unilateral headache thought to arise from impingement or entrapment of the occipital nerves and/or the
upper spinal vertebrae. Compression and injury of the occipital nerves within the muscles of the neck
and compression of the second and third cervical nerve roots are generally felt to be responsible for the
symptoms, including unilateral and occasionally bilateral head, neck, and arm pain. The criteria for
diagnosis of these entities currently include those of the International Headache Society (IHS) and the
Cervicogenic Headache International Study Group.
Various treatments have been advocated for cervicogenic headache and occipital neuralgia. Oral
analgesics and anti-inflammatory agents are effective for some patients, but there is a population of
patients who do not experience pain relief with these medications. Local injections, epidural steroid
injections, radiofrequency ablation of the planum nuchae, electrical stimulation, rhizotomy,
ganglionectomy, nerve root decompression, discectomy and spinal fusion have all been investigated in
the treatment of cervicogenic headache and occipital neuralgia.
Since medications provide only temporary relief and may cause side effects, surgical treatments such
as occipital neuroectomy and nerve decompression for migraine and other headaches have been
developed as a potential means to permanently prevent or to produce long-term remissions from
headaches.
Radiofrequency ablation is performed percutaneously. During the procedure, an electrode that
generates heat produced by radio waves is used to create a lesion in a sensory nerve with the intent of
inhibiting transmission of pain signal from the sensory nerve to the brain.
Neurostimulation or electrical stimulation is commonly used for control of chronic pain. Electrical
stimulation can be delivered in 3 ways: transcutaneously, percutaneously, and using implantable
devices.
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