Infiltrative cervical lesions causing symptomatic occipital neuralgia

Abstract

We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.

Headache with occipital neuralgia phenotype: Report of four cases

“…Several occipital and suboccipital structures such as vessels, dura mater of the posterior fossa, deep paraspinal neck muscle, and zygapophyseal joints are recognized as sources of head and neck pain. 2 Nociceptive inflow from these suboccipital structures is mediated by afferent fibres in the upper cervical roots terminating in the dorsal horn of the cervical spine extending from the C2 segment up to medullary dorsal horn. 3 In these four cases, pain with occipital neuralgia phenotype was the main initial symptom.…”

“…1 The literature describes several cases of infiltrative cervical lesions causing symptomatic occipital neuralgia, either with or without atypical findings in physical examination. 2…”

“…1 The literature describes several cases of infiltrative cervical lesions causing symptomatic occipital neuralgia, either with or without atypical findings in physical examination. 2 The second one had an artery dissection in which the only manifestation was paroxysmal occipital pain instead of a characteristic continuous cervical pain that has been describe in the criteria Headache or facial or neck pain attributed to cervical carotid or vertebral dissection in the ICHD-3 criteria. 4 Most of the cases of vertebral dissection have another symptoms apart from pain.…”

“…Abnormalities in general and/or neurological examination must raise the suspicion for underlying causes. Different aetiologies have been described 2 (Table 1). We report findings in four patients with secondary headache with occipital neuralgia phenotype evaluated between 2007 and 2018, at the Headache Clinic of FLENI, a tertiary neurological referral centre in Buenos Aires.…”

Occipital Neuralgia With Atypic Symptoms: A Case Report

“…Temporary relief of the symptoms with the anesthetic block of the occipital nerve can support the diagnosis (1,2). Among the secondary etiologies affecting cervical region, infectious conditions such as herpes zoster, neurosyphillis; inflammatory conditions such as osteoarthritis, myositis and fibrositis; vasculitides such as temporal arteritis; demyelinating diseases such as multiple sclerosis; systemic diseases such as arteriovenous malformations in craniocervical junction, Chiari malformation, trauma, gastrointestinal system tumor metastases, diabetes and gout; discopathies causing root or nerve compression; and primary and/ or secondary tumors of bone or cartilage affecting C2-C3 nerve root ganglia can be considered (3,4,5,17). In ON manifestations due to lesions capable of forming masses, such as Shwannom osteochondroma and artrosis, the intensity of the pain increases with neck motion due to mass effect and increase over time while being irresponsive to symptomatic treatments (14,15,16,17).…”