Occipital Neuralgia With Atypic Symptoms: A Case Report

Abstract

Re cei ved/Ge lifl Ta ri hi: 13.08.2013 Ac cep ted/Ka bul Ta ri hi: 14.02.2014 Cranial neuralgia is a rare form of headache disorders characterized with transient and unilateral attacks. Inflamatuar diseases and cervical compression are amongst the most common etiological factors even so idiopathic forms might be observed. International Classification of Headache Disorders (ICHD-2) made the classification of cranial neuralgias in 18 different groups. Occipital neuralgia, being a subgroup of cranial neuralgies, is a headache that involves anatomically at major, minor or third occipital nerve areas sometimes accompanying with sensory deficits or dysesthesia. Occipital neuralgia includes aching burning or throbbing headache that is often unilateral and continuous with intermittent shocking and shooting pain on the occipital nerve area. Patients with occipital neuralgia can be divided into those with structural causes and those with idiopathic causes. Structural lesions are cervical disc diseases, trauma, compression of the cervical discs. Tumors rarely metastasize to the paravertebral region and compression of the cervical nerve roots may result in occipital neuralgia. Our aim is to present a case with late onset medical refractory occipital neuralgia due to metastatic prostate cancer, emphasizing that relevant medical history should alert clinicans to the possibility of metastasis causing occipital neuralgia. Sum maryOksipital nevralji, büyük ve küçük oksipital sinirlerin bulunduğu arka oksipital bölgede hissedilen paroksismal bir baş ağrısıdır. Ağrı sıklıkla unilateral, zaman zaman şiddetlenerek elektrik çarpmasına benzer özellik gösteren, sürekli yanıcı-batıcı karakterdedir. Oksipital sinir alanı üzerine bası ile ağrı tetiklenir ve ağrıya duyarlılık eşlik edebilir. Oksipital nevralji sıklıkla idyopatik nedene bağlı olmakla birlikte nadiren enfeksiyonlar, osteoartrit veya vaskülit gibi enflamatuar hastalıklar, kök veya sinir basıları, travma, diyabet veya gut gibi sistemik hastalıklar ve C2-C3 sinir kökünü etkileyen tümörler gibi sekonder nedenlere bağlı olarak da ortaya çıkabilir. Özellikle atipik klinik sergileyen oksipital nevralji olgularında sekonder nedenler göz önünde bulundurulmalıdır. Bu bağlamda, ileri yaşta yeni başlayan ve medikal tedavilere dirençli bir oksipital nevralji olgusunu sunarak atipik olgularda ayrıntılı etiyolojik araştırmanın gerekliliğini vurgulamayı amaçladık. (Türk Nöroloji Dergisi 2014; 20:135-137 Özet

An atypical survey in a cluster headache patient: A case report

“…Sensory deficit or dysesthesia accompany this severe headache, localized in the upper neck and back of the head. [15] There was no change in pain characterization during compression or distortion of the patient's neck, so it is not ON, which usually affects the posterior part of the head. [2,16] It is different from TMJ headache, which is especially seen in women (our patient is a man), and it is known that CH is the most prevalent headache type in men.…”