Analgesic potentiation in post-traumatic occipital neuralgia, a case report

Abstract

Context: Occipital neuralgia is characterized as uni or bilateral pain in the topography of the occipital nerve. The condition may be harrowing or acute and worsens with digital pressure on the back of the neck. The pain appears in the distribution of the greater (GON), minor (LON), and third (TON) occipital nerves. Besides that, it may radiate to the retro-orbital region and angle of the mandible, and it can be associated with paresthesias. A less common cause is direct head trauma, and it is believed that the mechanism for its development is the injury or entrapment of the nerve fibers due to post-traumatic fibrosis. The conservative treatment consists of antiepileptics, tricyclic antidepressants, or antipsychotics. In addition, it includes anesthetic blockade of the GON, LON, and TON guided by ultrasonography of the skull, which is an essential option for treatment and identifies the presence of entrapment of the quoted structures. We present the case of a 37-year-old man, a victim of physical aggression with traumatic brain injury, without previous comorbidities or use of daily medications, who developed occipital neuralgia after the event. Cranial computed tomography showed occipital depression in the topography of the GON. Due to the absence of neurological alterations, the medical team chose conservative treatment with phenytoin. As the pain persisted, the professionals performed a hydro section and suboccipital block with anesthesia, resulting in improvements.