Occipital Neuralgia Case HistoryAn occipital neuralgia case history: A 42 year Left handed old grocer was referred from his GP with a 4 week history of "severe headaches". On the day of onset, he remembers feeling sick and went to vomit.On leaving the bathroom, he developed a sudden severe sharp pain in the right side of his head. There has been a dull ache in the right side of his head since. The pain has been "side-locked" to the right hand side and never generalised. Every few minutes, especially if he rotates his head to the left, there is a severe sharp shooting pain that shoots through from the back of the head into the eye and to behind the ear.The pain can be provoked by lying on his back. He has no past medical history, and there is no history of recent head or neck trauma. A quick neurological examination was normal. There was marked tenderness in the right sub-occipital area, but no change in sensation in the C2 or C3 territories. The clinical diagnosis was right occipital neuralgia. NSAIDS (diclofenac 50mg tid) and Gabapentin 300mg tid was recommended. A CT Brain excluded a posterior fossa abnormality, such as Chiari Malformation. Follow-up was arranged, with occipital nerve block to be attempted if no improvement from conservative treatment. Other diagnoses to consider are
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