MANIPAL

PUBLIC SCHOOL

PRINCIPLES FIRST

BIOLOGY INVESTIGATORY
PROJECT
SESSION 2019-20

SUBMITTED TO SUBMITTED BY
Ms. LUXMI RANI SHREYANSHI MISHRA
(PGT BIOLOGY) XII – B
CERTIFICATE
This is to certify that Shreyanshi Mishra of class XII-B, Manipal Public School, Lucknow
has successfully completed her project work in biology on

“Occipital Neuralgia” under my supervision. She has taken care and shown
sincerity in completion of this project.

I certify that this project is upto my expectation and as per guidelines issued for the
AISSCE by CBSE in the year 2019-20.

Date:

Registration no:

_______________________ ______________________
Ms. Luxmi Rani Ms. Anupama Shukla

(PGT Biology) (Principal)

Manipal Public School

_______________________

(Signature External Examiner)

ACKNOWLEDGEMENT
I would like to express my special thanks of gratitude to my
teacher Ms. Luxmi Rani as well as our principal Ms.
Anupama Shukla who gave me the golden opportunity to do
this wonderful project on the topic Occipital Neuralgia,
which also helped me doing a lot of research and I came to
know about so many new things, I am really thankful to
them.

Secondly, I would also like to thank my parents and friends

who helped me a lot in finalizing this project within the limited
time frame.
OCCIPITAL
NEURALGIA
Most feeling in the back and top of the head is
transmitted to the brain by the two greater
occipital nerves. There is one nerve on each
side of the head. Emerging from between bones
of the spine in the upper neck, the two greater
occipital nerves make their way through
muscles at the back of the head and into the scalp. They sometimes reach nearly as
far forward as the forehead, but do not cover the face or the area near the ears; other
nerves supply these regions.

Irritation of one of these nerves anywhere along its course can cause a shooting,
zapping, electric, or tingling pain very similar to that of trigeminal neuralgia, only with
symptoms on one side of the scalp rather than in the face. Sometimes the pain can
also seem to shoot forward (radiate) toward one eye. In some patients the scalp
becomes extremely sensitive to even the lightest touch, making washing the hair or
lying on a pillow nearly impossible. In other patients there may be numbness in the
affected area. The region where the nerves enter the scalp may be extremely tender.
 What causes occipital
neuralgia?
Occipital neuralgia may occur spontaneously, or as the result of a
pinched nerve root in the neck (from arthritis,
for example), or because of prior injury or
surgery to the scalp or skull. Sometimes
“tight” muscles at the back of the head can
entrap the nerves. Occipital neuralgia is a
headache syndrome that can be
either primary or secondary. Secondary
headaches are associated with an underlying disease that may
include tumor, trauma, infection, systemic disease or hemorrhage.

Although any of the following may be causes of occipital neuralgia,

many cases can be attributed to chronic neck tension or unknown
origins.

 Osteoarthritis of the upper cervical spine

 Trauma to the greater and/or lesser occipital nerves
 Compression of the greater and/or lesser occipital nerves or C2
and/or C3 nerve roots from degenerative
cervical spine changes
 Cervical disc disease
 Tumors affecting the C2 and C3 nerve
roots
 Gout
 Diabetes
 Blood vessel inflammation
 Infection
How is occipital
neuralgia diagnose?
There is not one test to diagnose occipital neuralgia. Your doctor may make
a diagnosis using a physical examination to find tenderness in response to
pressure along your occipital nerve. Your doctor may diagnose — and
temporarily treat — with an occipital nerve block. Relief with a nerve block
may help to confirm the diagnosis. For patients who do well with this
temporary “deadening” of the nerve, a more permanent procedure may be a
good option.

It can be difficult to distinguish occipital neuralgia from other types of

headaches — thus, diagnosis may be challenging. A thorough evaluation
will include a medical history, physical examination and diagnostic tests. A
doctor can document symptoms and determine the extent to which these
symptoms affect a patient's daily living. If there are abnormal findings on a
neurological exam, the doctor may order the following tests:
 Magnetic resonance imaging (MRI): A diagnostic test that produces
three-dimensional images of body structures using powerful magnets and
computer technology; can show direct
evidence of spinal cord impingement from
bone, disc or hematoma.

 Computed tomography scan (CT or CAT scan): A diagnostic image

created after a computer reads x-rays; can show the shape and size of
the spinal canal, its contents and the structures around it.
Treatment
Nonsurgical Options
Medications and a set of three steroid injections, with or without botulinum
toxin, can “calm down” the overactive nerves. Some patients respond well
to non-invasive therapy and may not
require surgery; however, some
patients do not get relief and may
eventually require surgical treatment.

There are other treatment options such

as burning the nerve with a radio-wave
probe or eliminating the nerve with a
small dose of toxin. However, these
are not always the best choice since
either treatment can permanently deaden the nerve, resulting in scalp
numbness.
Surgical Options
Surgical options include decompression of the greater occipital nerves
along their course, called occipital release surgery.

In this outpatient procedure, the surgeon

makes an incision in the back of the neck to
expose the greater occipital nerves and
release them from the surrounding
connective tissue and muscles that may be
compressing them. The surgeon can
address other nerves that may be
contributing to the problem, such as the
lesser occipital nerves and the dorsal
occipital nerves.

The surgery generally takes around two or

three hours and is performed with the patient asleep under general
anesthesia. Patients are able to go home the same day, and full recovery is
generally expected within one or two weeks.

In some cases, occipital release surgery only works temporarily, and the
pain returns. Further surgery to cut the greater occipital nerves can be
performed after about a year, however, this procedure is regarded as a last
resort since it would result in permanent scalp numbness.
What medications can you
use to treat occipital
neuralgia?
Your doctor may prescribe medications for you, including:

 Prescription muscle relaxants

 Antiseizure drugs, such as carbamazepine (Tegretol) and
gabapentin (Neurontin)
 Antidepressants
 Nerve blocks and steroid shots. The nerve block that your doctor
might do to diagnose your condition can be a short-term
treatment, too. It may take two to three shots over several weeks
to get control of your pain. It’s not uncommon for the problem to
return at some point and to need another series of injections.
Living with occipital pain.
This is a rare condition. The American Migraine Foundation reports that it only affects
3.2 people out of 100,000 every year. John Hopkins Medicine goes on to explain that
though many people will experience migraine pain in the back of, and on one side of
the head, the majority of these patients don’t actually suffer from this condition.

After reviewing a complete medical history and any imaging scans, they can make a
diagnosis. For those three people who are diagnosed with this condition, however, the
pain can be life-changing. Figuring out how to treat occipital neuralgia is a critical goal.
But further, many of the methods we discuss in this post for how to treat pain can also
be used to reduce and relieve pain in patients who are suffering from migraines
involving the greater occipital nerve.

1. Start with your diet

If you’re wondering how to treat occipital neuralgia, or chronic pain conditions of any
kind, it always pays to look first at your diet. Empowher.com explains

Other general recommendations for a pain-friendly diet include:

 Staying adequately hydrated

 Eating fresh and unprocessed foods as much as possible
 Reducing your sugar intake
 Incorporating more magnesium into your diet, or take as a supplement

2. Try at-home relaxation methods

Put simply, stress increases pain levels. For milder cases, therefore, start with at-home
methods to reduce tension and stress in your body. WebMD recommends resting in a
quiet room or applying heat to sore neck muscles. These simple methods likely won’t
cure these types of headache, but they can help reduce pain on a day-to-day basis.

3. Incorporate meditation into your day

Meditation is an important treatment method for all chronic pain patients. It
incorporates both mind and body approaches to healing, creates relaxation, and can
help you more fully understand your pain. Learn more about all the benefits of
meditation in our post “Easing Pain And Stress With Mindfulness Meditation.”

4. Book a massage
If simple relaxation doesn’t cut it, take it a step further. A massage can drastically help
you reduce tension that could be causing
your pain. You can:

 Ask your partner for a massage

 Perform a solo neck and jaw
massage

5. Learn more about cranial osteopathy

Cranial osteopathy is an advanced form of massage that targets the head specifically.
Health expert, Andrew Weil, MD, explains:

Find a list of physicians trained in osteopathic manipulation at The American Academy

of Osteopathy.
6. Consider how you’re sleeping
Too little sleep, too much pain. We’ve talked on the blog before about how sleep
issues can create more pain the following day. This
can then cause sleep issues the next night. It’s an
awful cycle that requires a big effort to help break.

7. Practice yoga for occipital

neuralgia pain
For pain associated with the occipital nerve, yoga could help. This centuries-old
practice is deeply healing and
restorative. LiveStrong.com recommends three
yoga poses that could help with occipital pain,
including:

 Sub-occipital neck stretch

 Neck rotation
 Neck extension and flexion

Four more yoga for neck pain poses include the following.

8. Do occipital strengthening exercises

TheNest.com recommends the following
strengthening exercise for occipital pain: the chin
tuck.
9. Try non-steroidal anti-inflammatory drugs
(NSAIDs) for acute cases
NSAIDs, like aspirin, may be appropriate for short bursts of mild to moderate occipital
neuralgia pain. Spine-Health.com notes that NSAIDs can reduce and relieve
inflammation that could be leading to head pain. Always be aware of how much of
these medications you’re taking, however, as they can cause gastrointestinal or
cardiovascular side effects.

10. Use topical medications for nerve pain

Topical medications are applied on the skin as a gel or cream. While they may not
work as well as some of the interventional options listed below, they can help reduce
sensation in affected areas. And, topical medications don’t have many of the same
side effects or run the risk for addiction or abuse that other medications have. Timothy
C. Hain, MD, on dizziness-and-balance.com, recommends talking to your doctor
about the following:

 Zostrix
 Xylocaine
 EMLA cream
 Ketamine lotion
 Lidocaine patch

11. Review your medication options for how to

treat occipital neuralgia
This condition doesn’t typically respond well to medications. However, if you’re
suffering from migraine pain that’s related to the occipital nerve, taking medications
along with other conservative methods could be the best occipital neuralgia treatment
for you. Drugs.com lists and reviews the medications that are related to treatment.

Your medication options may include:

 NSAIDs
 Antidepressants
 Anti-convulsant medications
 Muscle relaxants

As BlueCross BlueShield explains, many patients do use medications while

employing other treatments. This approach to pain management is at the cornerstone
of the field. If your pain hasn’t responded to medications or other at-home options, read
on for more information about interventional and complementary chronic pain
treatments.

12. Discuss behavioral modification therapy

with your doctor
HealthGrades.com recommends behavioral modification therapy, in conjunction with
medication. This type of therapy focuses on changing undesirable or negative
behaviors that could be leading
to pain.

Pain isn’t only in the body. It

also lives in the brain. By
tackling the pain from both the
body and mind aspects, you can
work towards less pain overall.
13. Try out acupuncture
Acupuncture is a minimally-invasive procedure. It aims to relieve pain by inserting
small needles into specific areas in the body. A practitioner places these needles at
known acupuncture sites that are either at the site of pain, or distantly contributing to it.

The pain relief associated with acupuncture is typically attributed to endorphins, or

pain-relieving hormones, being released into the body. Acupuncture can be a great
complementary option in coordination with other treatments.

14. Incorporate physical therapy into your

routine
Physical therapy, either focused on massage or muscle realignment, can be one of the
best conservative occipital neuralgia treatments. Even better, physical therapy has little
to no side effects so it can be used successfully with other interventions.

LiveStrong.com explains another benefit of

physical therapy:

Professional Rehabilitation Services gives a

more in-depth explanation of physical
therapy approaches your therapist may use.

15. Talk to a chiropractor

Chiropractic care is a highly-effective option for how to treat occipital neuralgia.
Through multiple cervical spine manipulations, a chiropractor can help reduce tension
and pain in this area. Like physical therapy,
chiropractic care has little to no side effects.
Learn more about the benefits of chiropractic
care in our post on the topic.

16. Find relief

with occipital nerve blocks
For moderate to severe cases, occipital nerve blocks are often the best method for
finding relief for patients. The National Institute of Neurological Disorders and Stroke,
part of NIH, recommends this option as a front-line treatment after at-home or
conservative treatments haven’t worked.

Occipital nerve blocks involve injecting a local anesthetic and steroid into the area of
the occipital nerve. This injection can block your pain sensations coming from the
occipital nerve. It can be used as either a therapeutic option, or as a diagnostic test to
confirm occipital nerve pain.

17. Talk to your doctor about

radiofrequency ablation
As TreatingPain.com explains, severe cases may be treated with radiofrequency
neurotomy (another name for ablation). This procedure involves interrupting the
sensory nerve supply to a joint through the use of thermal denervation. Studies on
radiofrequency neurotomy have shown that patients can experience pain relief for up
to 15 months, or even longer, after a procedure.

Our doctor explains how a radiofrequency ablation procedure takes place.

18. Read more about Botox for headaches
When you were wondering how to treat occipital neuralgia, you probably didn’t
consider Botox.

Botox injections for headaches are a fairly new area of treatment, but there is some
research backing this option. A study from Current Pain and Headache Reports found
that patients found significant headache pain relief during a four-week period following
Botox injections.

19. Try prolotherapy

Prolotherapy is a regenerative injection therapy that may help patients who haven’t
responded to nerve blocks or other more conservative treatments.

Ross A. Hauser, MD, explains more about this treatment option.

20. For hard-to-treat cases, consider surgery

When considering how to treat occipital neuralgia, surgery should always come after
you have tried other options with no relief.

The American Association of Neurological Surgeons discusses two options for surgical
treatments for extreme and severe cases of occipital neuralgia: microvascular
decompression and occipital nerve stimulation. On their website they explain the
following about these two procedures:
21. Learn more about your options for how to
treat occipital neuralgia
To find more information about how to treat occipital neuralgia, check
out PatientsLikeMe.com, which is a patient-driven site that compiles data from multiple
patients suffering from a condition.
On that site, you can see what
treatments have worked for other
patients and get feedback on any
treatments you’re considering.

Likewise, you can talk to a

specialized pain doctor who can
discuss all of these options with you
in more detail. Pain doctors are trained to treat pain with a comprehensive approach,
bringing in mind and body practices to help you successfully reduce your pain.
QUESTIONS FREQUENTLY
ASKED ABOUT OCCIPITAL
NEURALGIA

How can we relieve pain from

occipital neuralgia?

The first thing you’ll want to do when you have occipital neuralgia is to relieve
your pain. You can try to:

 Apply heat to your neck

 Rest in a quiet room
 Massage tight and painful neck muscles
 Take over-the-counter anti-inflammatory drugs, like naproxen or ibuprofen

Is occipital neuralgia serious?

It is called occipital because it affects the area around the occipital bone.
Pain associated with occipital neuralgia is often sudden and severe.
Symptoms can be alarming, but they are not usually associated with any
life-threatening health conditions.
What triggers occipital neuralgia?

Occipital neuralgia happens when there's pressure or irritation to

your occipital nerves, maybe because of an injury, tight muscles that entrap
the nerves, or inflammation. Many times, doctors can't find a cause for it.
Some medical conditions are linked to it, including: Trauma to the back of
the head.

Is occipital neuralgia serious?

It is called occipital because it affects the area around the occipital bone.
Pain associated with occipital neuralgia is often sudden and severe.
Symptoms can be alarming, but they are not usually associated with any
life-threatening health conditions.

Can occipital neuralgia be cured?

Can occiptal neuralgia be cured? For most patients, conservative therapy
or occipital nerve blocks are quite effective in relieving their pain. ... This type of
headache does not lead to other neurological conditions or nerve problems, even if left
untreated
How common is occipital neuralgia?

True isolated occipital neuralgia is actually quite rare. However, many other
types of headaches —especially migraines — can predominantly or
repeatedly involve the back of the head on one particular side, inflaming the
greater occipital nerve on the involved side and causing confusion as to the
actual diagnosis. These patients are generally diagnosed as having
migraines involving the greater occipital nerve, rather than as having
occipital neuralgia itself.

Where does occipital neuralgia hurt?

The pain usually originates at the base of the skull and radiates near the
back or along the side of the scalp. Some patients experience pain behind
the eye on the affected side. The pain is felt most often on one side of the
head, but may also affect both sides of the head.
BIBLIOGRAPHY

BOOK- MIGRAINE BOOK

NCERT BOOK

WEBSITE- WWW.AANS.ORG

WWW.NINDS.NIH.GOV

WWW.WEDMD.COM