Version July 2025
MRI: magnetic resonance imaging.
* Secondary causes of occipital neuralgia include peripheral nerve compression such as from arteriovenous malformations or meningioma and central conditions such as spinal cord infarction or demyelination. Refer to UpToDate for additional details on the secondary causes of occipital neuralgia.
¶ For patients who are unable to undergo or decline diagnostic occipital nerve block, a presumptive diagnosis of occipital neuralgia is made by compatible clinical features and neuroimaging that excludes alternative structural conditions. Diagnostic reassessment may be warranted for such patients who do not respond to initial pharmacologic treatment.
Δ Mimics of occipital neuralgia include conditions that cause occipital head or cervical pain and include muscle tension, cervical joint arthropathy, and vertebral artery injury. Refer to UpToDate topic for additional details on the differential diagnosis of occipital neuralgia.
◊ For initial dose and titration schedules refer to UpToDate topic on occipital neuralgia.
§ Selection of interventional procedure for refractory occipital neuralgia is determined by underlying cause, patient preference, and local expertise with available techniques. Refer to UpToDate topic for additional information.
