Occipital Neuralgia: Trigger Points and Non-Drug Treatments

Where are the trigger points in occipital neuralgia?

The trigger points in occipital neuralgia are the compression points along the greater occipital nerve. These include the C2 nerve root, the obliquus capitis inferior muscle, the semispinalis capitis muscle, instances where the nerve penetrates the trapezius muscle, and instances where the occipital artery and GON intersect. There are six major compression points along the course of the greater occipital nerve, including the semispinalis and obliquus capitis inferior muscles, and the trapezius muscle [16], [17].

What is Occipital Neuralgia?

The occipital nerve is a critical nerve leading from the base of the neck along the back of your head [1]. Occipital neuralgia is a chronic headache disorder that originates from the occipital region, the back of the head and spreads through the occipital nerves.

The pain experienced in occipital neuralgia is described as sharp, piercing, or stabbing, caused by damage or inflammation to the occipital nerve [2]. Occipital neuralgia is diagnosed according to the location of the pain, duration, and intensity. More specifically, the pain in occipital neuralgia is unilateral — meaning only on one side of the head [2]. Further neuroimaging may be involved to rule out other causes of pain.

What is the cause of occipital neuralgia?

Occipital neuralgia is characterised by severe occipital region pain, often caused by pinched nerves at the root of the neck. Individual attacks or episodes of occipital neuralgia can occur seemingly spontaneously or be triggered by a light touch [2, 3].

Just like neck problems can cause trigeminal neuralgia, tight neck muscles or chronic neck tension can also cause occipital neuralgia [2, 3].

Occipital neuralgia can be caused by entrapment of the greater occipital nerve within two muscles at the back of the neck: the semispinalis capitis [4] and the obliquus capitis inferior muscle [5].

Occipital neuralgia can also be caused by various other conditions, commonly including [2, 3]

• osteoarthritis - especially of the upper cervical spine, which can pinch nerves
• tumours affecting nerve roots
• blood vessel inflammation
• gout
• infection

Less common causes include trauma, fibrositis, myositis, fracture of the atlas, compression of the C-2 nerve root, C1-2 arthrosis syndrome, atlantoaxial lateral mass osteoarthritis, hypertrophic cervical pachymeningitis, cervical cord tumour, Chiari malformation, and neurosyphilis [6].

Occasionally, occipital neuralgia can be caused by pathological contact of the nerve with the occipital artery [7] or due to paravertebral pyomyositis and vertebral relapse of multiple myeloma [8].

Occipital neuralgia can also develop spontaneously, so-called idiopathic neuralgia [9].

Caffeine is known to be an adjunct chemical in many analgesic drugs, but caffeine withdrawal can also cause caffeine-induced occipital neuralgia.

Identifying Occipital Neuralgia Trigger Points

Occipital neuralgia is often triggered by specific actions or touch. Identifying these trigger points is crucial for diagnosis and treatment.

• The Neck: Occipital neuralgia is often caused by pinched nerves at the root of the neck, which can be due to tight neck muscles or chronic neck tension [2, 3].
• The Occipital Region: The occipital nerves run from the top of the spinal cord to the scalp, and any touch or pressure in this area can trigger a pain episode [2].
• Temporal and Suboccipital Areas. The temporal area is above the ears, also associated with Temporal lobe ADHD. The suboccipital trigger point is between the neck and back of the head, just around the dent. A comprehensive study of migraine trigger points found that about 74% of the total detected trigger points were in these areas [10].

Other triggers for occipital neuralgia pain can also be dietary substances, such as caffeine or bananas.

Gentle touching of the face or talking can activate trigger points and more targeted touch, pinch, or hits to these areas. In a study on trigeminal neuralgia, a condition similar to occipital neuralgia, gentle touches and talking were the most frequent manoeuvres triggering pain [11].

However, the location of trigger points can vary among individuals. Therefore, a healthcare professional's examination is necessary for accurate identification and treatment.

Occipital Neuralgia Trigger Points: Guiding Non-Drug Therapies

Occipital neuralgia can be managed through various non-drug therapies. These include physical therapy and exercise, massage, and acupuncture, which have been shown to relieve some patients [12, 2].

Physical Therapy for Occipital Neurlagia

Physical therapy, mainly manual therapy, is one approach that may help reduce muscle activity, decrease the number of headaches, and alleviate headache intensity. However, specific clinical studies on manual therapy for occipital neuralgia are limited, and more research is needed to confirm its effectiveness [12]. Physical exercise in trigeminal neuralgia has been effective, especially when targeting trigger points. These findings indicate the benefits of physical exercise therapy also in occipital neuralgia.

Massage for Occipital Neurlagia

Massage therapy can also alleviate pain, especially for treating pinched nerves caused by tight muscles [2]. Knowing the trigger points in trigeminal neuralgia is critical to identifying the correct places for massage.

Accupuncture for Occipital Neurlagia

Acupuncture has been widely used for pain conditions, including occipital neuralgia. Several studies have shown that acupuncture can improve occipital neuralgia symptoms. For instance, a review and meta-analysis found that acupuncture alone showed significant differences in efficacy compared to the control group treatment. The odds ratio was 4.96, indicating a nearly five-fold increase in the likelihood of symptom improvement with acupuncture [13].

Another study found that electroacupuncture combined with neural mobilization resulted in a total effective rate of 90.48%, suggesting a synergistic analgesic effect for electroacupuncture in occipital neuralgia trigger points [14]. In a case report, a patient experienced substantial resolution of her head pain after a single acupuncture treatment, with complete resolution after only a short course of care [15].

Remain cautious when attempting new non-drug therapies because although they may not be as harmful as incorrect drug therapies, incorrect physical therapy could exacerbate muscle tension and inflame occipital neuralgia trigger points.

Summary: Occipital Neuralgia Trigger Points

To summarise, there are well-defined occipital neuralgia trigger points where gentle brushing or touch can exacerbate pain. These trigger points are predominantly found at the back of the head and neck. Non-drug therapies utilise these trigger points to provide manual relief from muscle and nerve tension.