The Arnold's neuralgia, Also known as occipital neuralgia, it is a condition characterized by severe pain that runs from the back of the neck to the forehead. This condition can become serious and disabling.
The pain can be continuous or intermittent; When you move your neck, you may feel burning in the area. In addition, it can be accompanied by headaches and hypersensitivity of the scalp.
In Arnold's neuralgia it is a peripheral neuropathy. It is caused by irritation or inflammation of the occipital nerves, which consist of two nerves (minor and major). They extend from the top of the spinal cord (near the second and third vertebrae in the neck) to the scalp.
These peripheral nerves give sensitivity to the scalp and allow certain movements of the head. There is a nerve on each side of the head, sometimes reaching the forehead.
Thus, the pain can start from the base of the skull, pass through the neck and extend to behind the eyes. As well as on the back, the sides of the head and the front area.
However, these nerves do not reach the face or ears: therefore, it can often be confused with migraines or other types of headaches. But, it is not the same and you should receive a different treatment.
Thus, if an area near the occipital nerves is pressed with the fingers, accentuated pain may appear. To diagnose this condition without error, an anesthetic is injected into the nerve. If the pain is relieved or disappears completely, it is this disease.
Arnold's neuralgia usually resolves with rehabilitation and some drugs. If it is more resistant and severe, surgery can be used, such as stimulation of the occipital nerves.
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It is difficult to estimate the frequency of Arnold's neuralgia, since in many cases it is diagnosed as migraine.
There are migraines that mainly involve the back of the head, which are accompanied by inflammation of one of the occipital nerves. These patients are considered to suffer from migraines more than Arnold's neuralgia..
Thus, this condition appears to be rare (compared to migraine). According to the “Chicago Dizziness and Hearing (CDH)”, in 2014 they treated 30 patients with Arnold's neuralgia compared to about 3,000 with migraine. In this way, based on their experience, they affirm that there is one patient with Arnold's neuralgia for every 100 with migraines..
In addition, they indicated that this condition appears to be more common in women than in men (25 out of 30). The average age of onset is 52 years. Regarding the cause, the most common is a trauma to the head or neck.
Pain in the neck and head can come from any disease or disorder in any structure of the neck. There are 7 cervical vertebrae that surround the spinal cord. Between the vertebrae there are discs, the nerves of the neck being located very close.
In the neck there are several structures: muscles, arteries, veins, lymphatic glands, thyroid, parathyroid, esophagus, larynx and trachea. Some type of pathology in these areas could cause neck and / or headache pain.
In Arnold's neuralgia there is pressure, irritation or inflammation of the occipital nerves, for multiple causes. It is often difficult to find the exact cause that caused it.
This condition can appear spontaneously (primary) or be caused by other factors (secondary). For example, traumatic injuries, muscle strain or certain diseases. Below, you will see the most common pathologies associated with Arnold's neuralgia:
- Trauma to the back of the head or neck.
- Contracture or tension in the muscles that surround the occipital nerves, causing them to be compressed.
- Osteoarthritis: an affectation of the cartilage in which it wears away. Cartilage cushion the joints between one bone and another, allowing movement.
- Impingement of one of the occipital nerves.
- Herpes zoster neuritis.
- Infections.
- Degenerative cervical problems involving the occipital nerves, upper cervical roots, or ganglion root.
- Malformations or poor stability at the junction between the first vertebra of the spine (atlas) and the axis (the vertebra just below).
- Inappropriate postures, such as sustained cervical hyperextension.
- Gout. It is a type of arthritis in which uric acid accumulates in different areas of the body.
- Diabetes.
- Inflammation of the blood vessels in the neck or head.
- Neck tumors compressing the occipital nerve.
- Multiple sclerosis.
The main symptom is pain that is usually continuous, burning, and throbbing. Cramps or tingling may be experienced, or appear intermittently. It is a pain very similar to that of trigeminal neuralgia (only that the latter occurs in the face).
It extends from the base of the skull to the back of the head. It often occurs on one side of the head, although it can occupy both sides. Pain episodes can last from hours to days. Many patients report a pain-spasm-pain cycle.
In some cases, an extremely sensitive scalp can occur. These patients may notice paresthesia (tingling) in this area; as well as discomfort when combing your hair, washing your hair or even resting your head on the pillow.
Other symptoms are:
- Pain when rotating or extending the neck. As well as difficulties to move it.
- Pain can be evoked by pressing on the occipital nerves, between the nape and the base of the skull.
- Dizziness.
- Sensitivity to light (photophobia).
- Sensitivity to sounds.
- Pain can sometimes surround the eyes.
It is common for Arnold's neuralgia to be mistaken for migraines. In fact, if diagnosed and treated as a migraine, these patients will feel that the treatment has not been effective. It is very important that a proper diagnosis is made in order to develop a good treatment.
The “International Headache Society” (Headache Classification Committee, 2004) indicated that the diagnostic criteria for Arnold's neuralgia are: paroxysmal stabbing pains (internal pain that begins and ends suddenly) that may or may not be persistent.
This pain is located in the distribution of the major, minor and / or third occipital nerves. The fundamental thing for the diagnosis is that the pain is temporarily relieved by blocking the nerve through an anesthetic.
First, the doctor will ask questions about past medical history or injuries. On the other hand, you will carry out a physical exam. It consists of pressing firmly on the back of the head and the surroundings to check where the pain is located.
The definitive test is the injection of an anesthetic drug into the involved nerve. If pain is relieved, it is likely Arnold's neuralgia.
On some occasions, scan tests are done to observe the condition of the cervicals. Computed tomography or magnetic resonance imaging is often used; these are useful to check if the occipital nerve is being compressed.
In cases where another pathology (such as diabetes) is suspected that may have caused Arnold's neuralgia, it may be advisable to perform a blood test.
The goal of treatment is to break excessive stress on the nerve and reduce pain. If this condition is caused by other pathologies, it is best to treat the disease that causes it.
It may seem counterintuitive, but total rest is not entirely beneficial. The patient will be taught to perform exercises that gradually move the neck. Physiotherapeutic intervention is usually necessary.
To temporarily relieve pain, it is advisable to apply heat to the back of the neck. It is also advisable to have a massage to reduce the tension in the muscles of the affected area. In addition, it is possible to opt for acupuncture.
Another tip is to stay rested by sleeping in a quiet room. The mattress and pillow must be comfortable and of quality.
In episodes of acute pain, anti-inflammatory medications such as ibuprofen or naproxen may be taken to relieve symptoms, although this would not eliminate the cause of the problem.
If the pain is very bad and these medications do not work, your doctor may prescribe other types of medications. If deaf and continuous, indomethacin (anti-inflammatory) may be prescribed.
On the other hand, they can opt for muscle relaxants, anticonvulsant medications (gabapentin, carbamazepine; which are anti-neuralgic), antidepressants, and even cortisone injections.
The currently most successful technique for suppressing pain is the occipital nerve block. To do this, betamethasone (anti-inflammatory) and lidocaine (anesthetic) infiltrates the nerve. As indicated by Weiss et al. (2009), the pain is relieved during the first minutes and may disappear forever in certain cases.
Typically patients may need about two or three injections over weeks to eliminate pain. It may also happen that the pain reappears later, requiring a new series of injections..
This procedure has few adverse effects, although in a minority of patients some reactions have been found immediately after the infiltration, such as dizziness or puncture in the occipital artery..
In the long term, secondary symptoms can be alopecia, skin atrophy and loss of pigmentation in the puncture area..
In the event that the pain does not disappear with any of the mentioned treatments, surgery can be chosen. These methods are rarely used, and their risks and benefits must be weighed. The main surgical interventions are:
- Microvascular decompression: in this method it is done through microsurgery. The doctor detects and adjusts the blood vessels responsible for compressing the nerves. In this way, these blood vessels are gently displaced out of the point of compression..
This technique can decrease sensitivity, allowing the nerves to heal and adjust properly. The main nerves that are treated are the ganglionic, postganglionic and the C2 nerve root..
- Occipital nerve stimulation: It involves placing a neurostimulator on the occipital nerves, at the base of the skull. This device, once placed under the skin, emits electrical impulses to the painful area. Electrical impulses prevent pain messages from traveling from the occipital nerves to the brain.
There are certain basic habits that can be helpful in preventing Arnold's neuralgia. Some of them are:
- Avoid sleeping on your stomach, with your arm under the pillow.
- Do not talk on the phone for a long time with the device held between the ear and the shoulder.
- Try not to carry backpacks, bags or suitcases always on the same side. Try to switch between one arm and the other.
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