RSD/CRSP may cause Occipital Neuralgia requiring innovative and costly approaches to treatment for pain relief due to its unique nature.
Most of the 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 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 these nerves anywhere along their course can cause a shooting, zapping, electric, or tingling pain very similar to that of trigeminal neuralgia, only with symptoms located 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.
Occiptal Neuralgia may occur spontaneously, or as the result of a pinched nerve root in the neck (from arthritis, for example), or as the result of prior injury or surgery to the scalp or skull. Sometimes “tight” muscles at the back of the head can entrap the nerves.
The pain is caused by irritation or injury to the nerves, which can be the result of trauma to the back of the head, pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumors or other types of lesions in the neck. Localized inflammation or infection, gout, diabetes, blood vessel inflammation (vasculitis), and frequent lengthy periods of keeping the head in a downward and forward position are also associated with occipital neuralgia. In many cases, however, no cause can be found. A positive response (relief from pain) after an anesthetic nerve block will confirm the diagnosis.
Occipital neuralgia can be diagnosed—and temporarily treated—by an occipital nerve block. For patients who do well with this temporary “deadening” of the nerve, a more permanent procedure may be a good option. These treatments include cutting the nerve surgically, “burning” the nerve with a radio-wave probe, or eliminating the nerve with a small dose of an injected toxin.
Obviously any procedure that deadens the nerve permanently is likely to leave some degree of permanent numbness in the scalp. A few patients may do well with procedures that “spare” the affected occipital nerve—a surgeon could decompress the nerve by removing any impinging muscles or scar tissue, or a pain specialist could implant an occipital nerve stimulator, a pacemaker-like device that stimulates the nerve with electricity resulting in tingling rather than pain.