From the Research
Occipital neuralgia should be treated with conservative management as the first line of intervention, including physical therapy and other non-pharmacological treatments, as recommended by the most recent and highest quality study 1. The treatment of occipital neuralgia aims to reduce inflammation, relax muscles, and decrease nerve compression.
- Start with conservative management, including physical therapy, as it has mechanistic justification to treat symptoms and causes of occipital neuralgia 1.
- Physical therapy provided by a physical therapist, including exercise, manual therapy, posture and biomechanical training, TENS, patient education, and desensitization, can be beneficial in treating occipital neuralgia 1.
- For more severe pain, medication such as muscle relaxants or tricyclic antidepressants may be prescribed, but the use of these medications should be guided by the patient's clinical features and phenotype 2.
- Nerve blocks using lidocaine (1-2%) with or without steroids can provide temporary relief, but the duration of relief may be short-term 2.
- Other treatments, such as botulinum toxin and radiofrequency ablation, have shown promise, but require more research 3.
- Surgical decompression through resection of the obliquus capitis inferior is the definitive treatment, but there are significant risks associated with this procedure 3. It is essential to note that the treatment of occipital neuralgia should be personalized and based on the patient's clinical features, rather than solely on the diagnosis 1.
- The contemporary shift toward precision pain management emphasizes treatment based on a patient's constellation of clinical features, providing more personalized and specifically targeted pain treatment 1.
- Further research is required to determine the appropriate dosing, sequencing, and progression of conservative treatments for occipital neuralgia 1.