Representative Clinical Case: Occipital Neuralgia
The patient is a 44-year-old African-American female who presented with severe, lancinating occipital pain. Her medical history was notable for a motor vehicle collision resulting in a whiplash injury and a Chiari malformation for which she underwent decompression surgery. The pain was predominantly right-sided and described as constant, stabbing, and sharp and made worse with palpation and neck movement. The patient was neurologically intact on physical examination, although had a positive Tinel’s sign with exquisite tenderness to palpation over the greater occipital nerve on the right side predominantly, as well as the left side to some degree. She achieved notable but transient pain relief with selective occipital nerve blocks and transcutaneous electrical nerve stimulation. Anticonvulsant medications resulted in pain relief initially, but were less effective over time.
KeywordsOccipital neuralgia Occipital nerve stimulation Greater occipital nerve Cervicogenic headache Neuromodulation Refractory
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