Neuralgia of the occipital nerves (Major and Minor Occipital) is a very common cause of severe headaches. These nerves are formed by nerve branches of the 2^from and 3^from spinal cord nerve roots in the neck (A2-A3 spinal roots).

The classic occipital neuralgia headache is located at the back of the head, specifically at the occiput and the top of the neck. However, because these nerves are also connected to the trigeminal nerve, (the nuclei of the A2-A3 spinal roots are connected to the nucleus of the trigeminal nerve in the brainstem , forming the mixed trigeminal nucleus), occipital neuralgia headache may also be located elsewhere in the head such as in the posterior region of the eyes (patients typically report pain in the eyes or behind the eyes), or in any other trigeminal nerve area of the face. Also because of their proximity to the occipital artery, (the greater occipital is right next to it), when there is pressure or entrapment of the nerve, the pain can also be throbbing (like a hammering) in nature because the artery is spasming. It may even be accompanied by nausea and vomiting. The occipital nerves , because of their position and course, are easily injured and trapped by repetitive daily movements (flexion-extension of the neck), by poor sleeping posture, by exposure to cold, and by spasm of the trapezius muscle.

The nerve infiltration with a small amount of local anesthetic (lidocaine or procaine) along with a small amount of cortisone (optional), is an easy and safe technique that is performed in our clinic and offers relief from the very first session. It lasts a few minutes and the patient is not inconvenienced while returning to work after a short time. Usually a few sessions are required for the permanent disappearance of the symptoms, and necessary instructions are given for some changes in his daily routine, such as avoiding certain movements, change in sleeping posture (avoiding too many pillows) , reducing stress and exercise.

Infiltration of the lesser occipital nerve

The patient is in a prone position on the examination bed (prone) or seated with the head slightly bent. The head is palpated to locate the occipital nerves, always guided by the occipital artery, which is easily palpated to avoid injury to it. The area is then antisepticised and the nerves are perfused. Usually these patients have other painful points in neighbouring areas (firing points in neighbouring muscles), so additional injections may need to be made in these areas. Also, some branches of the trigeminal nerve may need to be blocked, depending on the patient's symptoms, due to its connection with the occipital nerves.