Trigeminal and Occipital Neuralgia - Pain Doctor (2023)

If you suffer from severe headache or facial pain, you may want to learn more about trigeminal and occipital neuralgia. Neuralgia is nerve-related pain, with trigeminal neuralgia and occipital neuralgia being two of the most potentially disabling types. Trigeminal neuralgia and occipital neuralgia affect different parts of the head. Both can cause symptoms that range in severity from mild stinging to migraines so severe that they induce vomiting. There are a few similarities between the two conditions, such as treatment methods, but the main difference between the two is which nerve is affected.

Differences between trigeminal neuralgia and occipital neuralgia

Trigeminal neuralgia and occipital neuralgia are similar, but there are differences.trigeminal neuralgiaThis is neuralgia related to the trigeminal nerve. This type of neuralgia is caused by damage, inflammation, or irritation of the trigeminal nerve. On the other hand, in occipital neuralgia, the occipital nerve is affected.

trigeminal neuralgia

On each side of the face is the trigeminal nerve, and each nerve is divided into three branches. It provides facial sensory and motor innervation to the muscles used for chewing and swallowing.

• The first branch is the optic nerve (V1), which runs through the scalp and forehead, the upper eyelid, the conjunctiva and cornea of ​​the eye, the nose and the frontal sinuses.
• The second branch is the maxillary nerve (V2), which runs through the lower eyelid, cheek, upper lip, teeth and gums, nasal mucosa, palate, part of the pharynx, maxillary, ethmoid and sphenoid sinuses.
• The third branch is the mandibular nerve (V3) which runs through the lower lip, teeth and gums, floor of the mouth, anterior tongue, chin, jaw and parts of the outer ear. The mandibular branch is a nerve responsible for motor functions.
• All three branches supply parts of the meninges.

paintrigeminal neuralgiaThese can be occasional bouts of pain, regular bouts of intense pain, continuous pain, or a series of painful attacks that come and go regularly over a period of days or weeks. Activities such as eating, talking, and even feeling the breeze on your cheek can sometimes trigger an attack.

The pain of trigeminal neuralgia may be limited to the area covered by the branch of the trigeminal nerve. The pain is usually limited to one side of the face, but in rare cases there may be pain on both sides of the face. In extremely rare cases, pain can be felt on both sides of the face at the same time.

occipital neuralgia

Woccipital neuralgiathis applies to the occipital nerve.

The occipital nerve runs from the top of the spinal cord to the neck and scalp. When the occipital nerve is damaged, inflamed, or irritated, a person may experience pain that starts at the back of the head and radiates forward.

There may also be pain behind the eye, tenderness of the scalp, sensitivity to light, or pain when moving the neck. Since there are two occipital nerves running from the neck to the scalp, it is possible to feel pain on only one side of the head at a time.

Washing your hair or lying on your pillow can become very difficult. In addition, pain is associated withoccipital neuralgiaIt can be similar to other headache conditions, so it's easy to mistake occipital headaches or migraines for something else and go undiagnosed.

You can learn more about occipital neuralgia in the video below.

Conditions associated with trigeminal and occipital neuralgia

There are certain conditions that are commonly associated withfrom nerwo, although the type is not limited to occipital neuralgia and trigeminal neuralgia.

Some of these conditions are:

• multiple sclerosis
• fibromyalgia
• porphyria
• Certain infections, such as AIDS or shingles
• chronic renal failure
• some medications

Causes of occipital and trigeminal neuralgia

When it comes to trigeminal and occipital neuralgia specifically, there are very few risk factors. More women develop this type of neuralgia than men. The risk of trigeminal neuralgia is also increased in people over the age of 50.

Nerve root compression is an often recognized cause of trigeminal and occipital neuralgia. In 80-90% of cases, it is an abnormal loop of an intercranial artery or, less commonly, a vein that compresses the nerve root near where it enters the brainstem. As a result, the nerve works erratically, occasionally sending out pain signals when you touch it, chew it, or brush your teeth.

Rarely, traumatic nerve damage, such as a car accident, can cause similar damage. In multiple sclerosis, loss of myelin in one or more trigeminal nuclei can also cause trigeminal and occipital neuralgia. Other less common causes of compression include tumors, epidermoid cysts, and aneurysms. The compression then damages the nerve's protective sheath, called myelin.

Treatment of occipital neuralgia and trigeminal neuralgia

Many treatments focus on pain control, although there are surgical procedures that can provide more lasting relief.

If the pain from trigeminal neuralgia or occipital neuralgia is not too severe, you may want to try home treatments to find some relief. Resting in a quiet room, neck massage, or warming up may help. Over-the-counter painkillers, such as Advil or Tylenol, can also relieve symptoms.

It is known that dealing with facial pain with current medical and surgical treatments is very difficult, but it can be helpful for people who do not respond to more conservative treatments. Standard medical treatments are anti-inflammatory, anticonvulsant and antidepressant medications. After these fail, local anesthetic blocks are tried, but they only provide temporary pain relief. Finally, percutaneous or open procedures can be performed, and even more rarely neurostimulation. However, peripheral nerve stimulation is a more likely option for treating chronic facial pain.

Medications for occipital neuralgia and trigeminal nerve

Pharmacological treatment is usually the first-line treatment. Carbamazepine is more effective and usually has manageable side effects. If not effective or not tolerated, combination with gabapentin, phenytoin, baclofen, lamotrigine, topiramate or tizanidine may be beneficial.

In patients experiencing pain relief, periodic dose reductions are recommended to control occasional sustained remission.

interventional pain management

radiofrequency ablationhas a fairly high success rate in treating various types of neuralgia. This procedure involves cauterizing painful nerves to cut off pain signals. Most likely, the nerve will eventually heal, which usually means the return of pain from trigeminal or occipital neuralgia. However, if successful, the procedure can be repeated.

Injectable medications can also be effective in relieving pain. Nerve block injections usually contain an anesthetic such as lidocaine. Some also contain a steroid to reduce inflammation. These injections are given directly into the affected nerve. receiving patientsnerve block injectionsyou often feel relief very quickly. Nerve block injections are also very helpful in diagnosis.

complementary therapies

Sometimes alternative therapies are also helpful.Acupunctureit is the strategic insertion of fine and sanitized needles to relieve pain.chiropractic careit can sometimes be effective, although it's always a good idea to discuss alternative treatments with your doctor before using them.

Another possible alternative treatment is abotulinum injection. These injections are primarily known for their cosmetic uses as botulinum is actually a paralyzing toxin. This can be helpful in smoothing facial wrinkles, but it can also block impulses sent along nerves, blocking pain signals.

Surgery of the occipital neuralgia and the trigeminal nerve

More extreme treatments, such as surgery, carry greater risks, so it's important to have a solid diagnosis before having any surgery. For example, if injection of a nerve block into the occipital nerve provides pain relief, then surgery targeting the occipital nerve has a good chance of relieving pain.

If other options have not worked, there are several options for surgical intervention. These operations include:

• Microvascular decompression: An invasive procedure that removes or separates the vascular system, which is often the superior cerebellar artery, away from the nerve.
• Balloon compression: A balloon catheter is inflated and used to compress the knot.
• Gammames radiosurgery: A non-invasive treatment that creates lesions using targeted gamma radiation. Radiation is directed to the proximal nerve root using a stereotaxic frame and MRI.
• Linear Accelerator Radiosurgery: A non-invasive approach similar to the gamma knife but uses a different form of radiation, linear acceleration.
• Peripheral neurectomy: An incision, radiofrequency injury, alcohol injection, or cryotherapy is used on the peripheral branch of the nerve.
• Chemical rhizotomy: injection of glycerol into the trigeminal cistern. There is a tingling or burning sensation on the face, and pain relief is usually immediate, but may take up to a week.

Surgery to treat trigeminal neuralgia or occipital neuralgia are the riskiest treatment options, but can potentially provide long-term relief if nothing else has worked.

Living with trigeminal and occipital neuralgia

If you are suffering from pain that may be occipital neuralgia or trigeminal neuralgia, a pain doctor can help you diagnose and find appropriate treatment options. If conservative or home treatments haven't helped your pain, click the button below to speak with a pain doctor in your area.