Occipital Neuralgia and Multiple Sclerosis: The Symptoms and Treatments

The Connection Between Occipital Neuralgia and Multiple Sclerosis

Occipital neuralgia is a distinct type of headache disorder characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the eyes. This condition is caused by irritation or damage to the occipital nerves, which run from the top of the spinal cord at the neck up through the scalp.

Research indicates that occipital neuralgia may be more common in people with multiple sclerosis (MS). MS is a progressive disease of the central nervous system in which the immune system attacks and damages the myelin sheath surrounding nerve fibers. This damage causes communication problems between the brain and rest of the body, resulting in an array of physical, cognitive, and psychological symptoms.

The Link Between Occipital Neuralgia and MS

Studies show that approximately 30-40% of people with MS experience occipital neuralgia, compared to an estimated 3.2% prevalence in the general population. There are a few theories that may explain the higher occurrence of this headache disorder in MS:

• Nerve inflammation - The nerve inflammation that contributes to MS damage may make the occipital nerves more prone to irritation. Increased sensitivity along these nerves can trigger headache pain.
• Lesions - Brain lesions that occur with MS can damage or put pressure on the occipital nerves and surrounding blood vessels, leading to occipital neuralgia symptoms.
• Muscle tightness - Spasticity and muscle tightness in the neck and shoulders, common MS symptoms, may compress or squeeze the occipital nerves.
• Trigeminal neuralgia - Some research finds an association between trigeminal neuralgia (facial pain) and occipital neuralgia in MS patients, suggesting a link between damage to both trigeminal and occipital nerves.
• Head position - Spending extended time with the head tilted forward may contribute to occipital nerve compression and irritation in MS patients with mobility limitations or muscular weakness.

Occipital Neuralgia Symptoms

The hallmark symptom of occipital neuralgia is headache pain concentrated in the rear and upper areas of the head. Characteristics of this headache pain may include:

• Burning, stabbing, or electric shock-like pain
• Pain centered at the base of the skull that may radiate to the scalp, forehead, or behind the eyes
• Pain triggered or exacerbated by touch or pressure to the base of the head or upper neck
• Head pain that follows the distribution path of the greater or lesser occipital nerves
• Pain that feels one-sided (unilateral) or on both sides (bilateral)
• Headache attacks that come and go

Some people with occipital neuralgia also experience pain or numbness traveling down the neck toward the shoulders and arms. Other associated symptoms may include dizziness, lightheadedness, nausea, vision changes or eye pain with eye movement.

Diagnosing Occipital Neuralgia

Since the symptoms can mimic other headache disorders like migraines, getting an accurate diagnosis is important. To diagnose occipital neuralgia, a neurologist will:

• Ask about your headache symptoms and medical history
• Conduct a physical exam of the head, neck and shoulders
• Check for tenderness over the occipital nerves
• Have you keep a headache diary to track symptoms
• Order imaging tests like an MRI to rule out structural problems
• Use nerve block injections to help confirm occipital nerve involvement

Ruling out other causes of head pain helps confirm that irritation of the occipital nerves is the root cause of the symptoms.

Occipital Neuralgia Treatment Options

Treatments for occipital neuralgia aim to alleviate nerve irritation and reduce pain levels. Treatment approaches may include:

• Medications - Over-the-counter pain relievers, prescription medications like anti-seizure drugs or antidepressants, nerve blocks, and Botox injections can help manage pain.
• Nerve blocks - Injections of anesthetic numbing medication and/or steroids directly into the occipital nerves may temporarily relieve pain.
• Physical therapy - Stretching, massage, posture correction may provide pain relief by releasing muscle tension on nerves.
• Lifestyle changes - Applying heat/ice packs, stress management, staying hydrated, stretching breaks can help.
• Occipital nerve stimulation - A small device can be surgically implanted to deliver mild electrical signals to the occipital nerves to disrupt pain signals.
• Surgery - If more conservative treatments fail, surgically decompress or remove damaged occipital nerves may be an option.

Finding the right treatment or combination of therapies takes some trial and error. Patience is needed to find the most effective approach for long-term pain relief.

Coping With Occipital Neuralgia and MS

Living with both MS and occipital neuralgia can be very challenging. Severe head pain on top of other MS symptoms can greatly impact your comfort and quality of life. Here are some tips for coping with this "double diagnosis":

• Track your headache patterns and triggers so you can anticipate attacks.
• Practice relaxation techniques like deep breathing, mindfulness, yoga.
• Use good posture and ergonomics to reduce neck strain.
• Apply warm or cold compresses to head and neck for pain relief.
• Reduce stress through counseling, support groups, or other outlets.
• Get rest during headache flares.
• Ask for help around the house when needed.
• Communicate regularly with your doctor about symptoms.
• Stay connected with encouraging friends and family.

While dealing with two complex conditions is far from easy, being an advocate for your own health and wellbeing makes a big difference. There are many approaches for managing occipital neuralgia and MS available, so don't give up hope. With patience and the right treatment plan, many people achieve significant pain reduction and improved quality of life.

The Bottom Line

Occipital neuralgia appears to occur more frequently in those with MS compared to the general population. The exact mechanisms for this connection are still being investigated. Since both MS and occipital neuralgia cause debilitating nerve-related symptoms, managing both conditions at once can feel overwhelming. However, a variety of treatments are available to alleviate occipital nerve pain and its impact on daily life. Working closely with your neurologist and MS healthcare team allows you to explore a multifaceted approach to pain management. There are many reasons to be hopeful - significant pain relief is possible so you can enjoy greater comfort and restored quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.