Occipital Neuralgia Secondary to Respiratory Tract Infection

Occipital neuralgia is an extracranial pain that may be confused with other headaches. It can be attributed to multiple causes. The authors report the case of a 55-year-old woman suffering from right occipital neuralgia secondary to respiratory tract infection that began 6 days before the pain started. The patient suffered from a sharp and burning pain with paroxysms in the right occipi-tal region and at the top of the right ear. Sensation was decreased in the affected area, and hypersensitivity to touch and cold water was also noted. Tinel’s sign was present, and local anesthetic block produced pain relief. The combination of gabapentin and amitriptyline did not provide significant pain relief but led to marked adverse effects. Carbamazepine (300 mg/d) was required for pain control. A month later the patient appeared totally pain-free. The treatment was continued for 3 months, and the patient remained pain-free over a subsequent follow-up period of more than 6 months. Thus, in the case of occipital pain, a careful assess-ment of symptoms and a thorough history are necessary to obtain the correct diagnosis and to choose the appropriate treatment plan.

head and neck; infection; occipital nerves; occipital neuralgia; respiratory tract

1. Merskey H. Classification of chronic pain. Pain 1986;(suppl 3):1–226.

2. Magnusson T, Ragnarsson T, Bjornsson A. Occipital nerve release in patients with whiplash trauma and occipital neuralgia. Headache 1996;36:32–36.

3. Hammond SR, Danta G. Occipital neuralgia. Clin Exp Neurol 1978;15:258–270.

4. Bogduk N. The anatomy of occipital neuralgia. Clin Exp Neurol 1980;17:167–184.

5. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 1988;8(suppl 7):61–71.

6. Graff-Radford SB, Jaeger B, Reeves JL. Myofascial pain may present clinically as occipital neuralgia. Neurosurgery 1986;19:610–613.

7. Kuhn WF, Kuhn SC, Gilberstadt H. Occipital neuralgias: Clinical recognition of a complicated headache. A case series and literature review. J Orofac Pain 1997;11:158–165.

8. Sjaastad O, Fredriksen TA, Stolt-Nielsen A. Cervicogenic headache, C2 rhizopathy and occipital neuralgia: A connection? Cephalalgia 1986;6:189–195.

9. Couch JR. Treatment of facial and scalp neuralgias. In: Gallagher RM (ed). Drug Therapy for Headache. New York: Marcel Dekker, 1991:255–273.

10. Kerr FWL. Mechanisms, diagnosis and management of some cranial and facial pain syndromes. Surg Clin North Am 1963;43:951–961.

11. Berry M, Bannister HL, Standring MS. Nervous system. In: William LP (ed). Gray’s Anatomy: The anatomical basis of medicine and surgery, ed 38. Edinburgh: Churchill Livingstone, 1995:1238–1264.

12. Anthony M. Headache and the greater occipital nerve. Clin Neurol Neurosurg 1992;94:297–301.

13. Knox DL, Mustonen E. Greater occipital neuralgia: an ocular pain syndrome with multiple etiologies. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol 1975;79:513–519.

14. Clavel M, Clavel P. Occipital neuralgia secondary to exuberant callus formation. Case report. J Neurosurg 1996;85:1170–1171.

15. Cerrato P, Bergui M, Imperiale D, et al. Occipital neuralgia as isolated symptom of an upper cervical cavernous angioma. J Neurol 2002;249:1464–1465.

16. Post AF, Narayan P, Haid RW. Occipital neuralgia secondary to hypermobile posterior arch of atlas. Case report. J Neurosurg 2001;94:276–278.

17. Eriksson M, Ben-Menachem E, Andersen O. Epileptic seizures, cranial neuralgias and paroxysmal symptoms in remitting and progressive multiple sclerosis. Mult Scler 2002;8:495–499.

18. Gonzalez-Gay MA, Garcia-Porrua C, Branas F, Alba-Losada J. Giant cell arteritis presenting as occipital neuralgia. Clin Exp Rheumatol 2001;19:479.

19. Smith DL, Lucas LM, Kumar KL. Greater occipital neuralgia: An unusual presenting feature of neurosyphilis. Headache 1987;27:552–554.

20. Baer-Henney S, Tatagiba M, Samii M. Osteochondroma of the cervical spine causing occipital nerve neuralgia. Case report. Neurol Res 2001;23:777–779.

21. Ballesteros-Del Rio B, Ares-Luque A, Tejada-Garcia J, Muela-Molinero Alberto. Occipital (Arnold) neuralgia secondary to greater occipital nerve schwannoma. Headache 2003;43:804–807.

22. Markman J, Oaklande AL. Neuropathic pain syndromes. In: Ballantyne J, Fishman S, Salahadin A (eds). The Massachusetts General Hospital Handbook of Pain Management. Philadelphia: Lippincott Williams & Wilkins, 2002:349–351.

23. Eliav E, Herzbery U, Ruba M, Bennett G. Neuropathic pain from experimental neuritis of the rat sciatic nerve. Pain 1999;83:169–182.

24. Quinn JP, Dalziel RG, Nash AA. Herpes virus latency in sensory ganglia—A comparison with endogenous neuronal gene expression. Prog Neurobiol 2000;60:167–179.

25. Stechison MT, Mullin BB. Surgical treatment of greater occipital neuralgia: An appraisal of strategies. Acta Neurochir 1994;131:236–240.

26. Duduisson D. Treatment of occipital neuralgia by partial posterior rhizotomy at C1-3. J Neurosurg 1995;82:581–586.

27. Arner S, Lindblom U, Meerson BA, Molander C. Prolonged relief of neuralgia after regional anesthetic blocks. A call for further experimental and systematic clini-cal studies. Pain 1990;43:287–297.

28. Diamond S. Cervical spine disease and muscle contraction headache. In: Dalessio DJ (ed). Wolff’s Headache and Other Head Pain, ed 5. New York: Oxford University Press, 1987:182–186.