Occasional Headache
Occipital neuralgia is a condition in which the nerves that run from the top of the spinal cord up through the scalp, called the occipital nerves, are inflamed or injured. You might feel pain in. This causes pain in a localised area of the scalp (“nummular” means coin). The pain can be dull, and pressure-like, which leads to a mis-diagnosis of tension-headache. Inside this area of dull headache, sharp head pains occur. The scalp is tender at the site of pain, and a small circular area of hair loss can appear in the painful area. About 30 to 80 percent of the adult population in the United States suffers from occasional tension-type headaches. Chronic daily tension-type headaches affect approximately 3% of the population; women are twice as likely to suffer from them as men.
Headache In Back Of Head
Nearly all women have occasional headaches, but having a headache in pregnancy is not fun. And, managing headaches is especially tricky in the first trimester when you should avoid many medicines. Whether your headache is from tension or is a full-blown migraine, there are some things you should know.
What causes headaches in pregnancy?
The exact cause of a headache isn’t always clear. In the first trimester, changing hormone levels and blood volume may play a role. A dull, overall headache can come with stress, fatigue, and eyestrain. Sinus headaches may be more likely because of the nasal congestion and runny nose that are common in early pregnancy. Hunger and low levels of blood sugar can trigger headaches, too. Women who suddenly stop their morning coffee and sodas may experience caffeine withdrawal headaches. Those who also suffer with nausea and vomiting in early pregnancy can become dehydrated. This can also bring on a headache.
Migraine headaches are a common type of headache in pregnancy. These painful, throbbing headaches are usually felt on one side of the head and result from expansion of the blood vessels in the brain. The misery is sometimes accompanied by nausea, vomiting, and sensitivity to light. A small percentage of women with migraines also have an aura with the migraine. They see flashes of light or feel tingling in their arms and legs.
When should I be concerned?
When a headache is severe, or just doesn’t go away, or when you have dizziness, blurred vision, or changes in your field of vision, you should contact your healthcare provider. Headaches can sometimes be related to blood pressure problems in pregnancy. If they are persistent or severe and happen after 20 weeks of pregnancy, let your healthcare provider know. Although strokes during pregnancy are rare, migraines can increase a pregnant woman’s risk for them. If you have migraines, report them to your healthcare provider.
What can I do about headaches?
Steps to manage headaches include the following:
Avoid any known headache triggers, including allergens and certain foods, like monosodium glutamate, cured meats, and strong cheeses.
Smoking is never a good idea in pregnancy. You should also avoid secondhand smoke.
Try to eat well and drink plenty of fluids, especially if you are prone to morning sickness.
Reduce your stress level. Try a massage or cold pack to help with tension headaches.
If your headache is a migraine, rest in a cool, dark room with no noise, and try using warm or cold compresses or an ice pack.
There is good news, however. Most women have fewer headaches during pregnancy, especially after the first trimester. And those with a history of migraines often find there is improvement during pregnancy.
What is occipital neuralgia?
Most feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. There is one nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two greater occipital nerves make their way through muscles at the back of the head and into the scalp. They sometimes reach nearly as far forward as the forehead, but do not cover the face or the area near the ears; other nerves supply these regions.
Irritation of one of these nerves anywhere along its course can cause a shooting, zapping, electric, or tingling pain very similar to that of trigeminal neuralgia, only with symptoms on one side of the scalp rather than in the face. Sometimes the pain can also seem to shoot forward (radiate) toward one eye. In some patients the scalp becomes extremely sensitive to even the lightest touch, making washing the hair or lying on a pillow nearly impossible. In other patients there may be numbness in the affected area. The region where the nerves enter the scalp may be extremely tender.
What causes occipital neuralgia?
Occipital neuralgia may occur spontaneously, or as the result of a pinched nerve root in the neck (from arthritis, for example), or because of prior injury or surgery to the scalp or skull. Sometimes 'tight' muscles at the back of the head can entrap the nerves.
How is occipital neuralgia diagnosed?
There is not one test to diagnose occipital neuralgia. Your doctor may make a diagnosis using a physical examination to find tenderness in response to pressure along your occipital nerve. Your doctor may diagnose — and temporarily treat — with an occipital nerve block. Relief with a nerve block may help to confirm the diagnosis. For patients who do well with this temporary 'deadening' of the nerve, a more permanent procedure may be a good option.
How common is occipital neuralgia?
True isolated occipital neuralgia is actually quite rare. However, many other types of headaches —especially migraines — can predominantly or repeatedly involve the back of the head on one particular side, inflaming the greater occipital nerve on the involved side and causing confusion as to the actual diagnosis. These patients are generally diagnosed as having migraines involving the greater occipital nerve, rather than as having occipital neuralgia itself.
Treatment
Nonsurgical Options for Occipital Neuralgia
Occasional Headache And Nausea
Medications and a set of three steroid injections, with or without botulinum toxin, can 'calm down' the overactive nerves. Some patients respond well to non-invasive therapy and may not require surgery; however, some patients do not get relief and may eventually require surgical treatment.
There are other treatment options such as burning the nerve with a radio-wave probe or eliminating the nerve with a small dose of toxin. However, these are not always the best choice since either treatment can permanently deaden the nerve, resulting in scalp numbness.
Surgery for Chronic Headaches: Is it Right for You?
Surgical Options for Occipital Neuralgia
Surgical options include decompression of the greater occipital nerves along their course, called occipital release surgery.
In this outpatient procedure, the surgeon makes an incision in the back of the neck to expose the greater occipital nerves and release them from the surrounding connective tissue and muscles that may be compressing them. The surgeon can address other nerves that may be contributing to the problem, such as the lesser occipital nerves and the dorsal occipital nerves.
The surgery generally takes around two or three hours and is performed with the patient asleep under general anesthesia. Patients are able to go home the same day, and full recovery is generally expected within one or two weeks.
In some cases, occipital release surgery only works temporarily, and the pain returns. Further surgery to cut the greater occipital nerves can be performed after about a year, however, this procedure is regarded as a last resort since it would result in permanent scalp numbness.