Occipital neuralgia with and without migraine: difference in pain characteristics and risk factors

We conducted this study to identify differences in presentation and symptomatology between patients with isolated occipital neuralgia (ON) and patients with ON who also had migraine headache (ON + M).

Occipital neuralgia is an uncommon cause of headaches. Very little is known about the pain characteristics and associated features of patients with ON + M and whether these pain characteristics differ from those of patients with isolated ON.

We studied 35 consecutive patients presenting with ON to the University of Southern California headache clinic. All patients met International Headache Society criteria for diagnosis of ON. Patients completed a questionnaire designed for this study. We also collected demographic data, including age, gender, and ethnicity.

Twenty patients had ON + M and 15 had isolated ON. There was no difference in age, gender or ethnicity between patients with ON + M and those with isolated ON. Patients with ON + M had significantly more complaints of pain traveling to the scalp and presence of scalp tenderness and tingling compared with patients with isolated ON; 25% patients in the ON + M group described the pain as "dull" whereas none of the isolated ON group reported this characteristic. There was higher use of chiropractors and massage therapy in patients from ON + M group than from isolated ON.

There may be significant differences in pain characteristics for patients with ON + M and those for patients with isolated ON. The data indicate that patients with migraine should also be screened for symptoms of ON, as there may be similarities in presentation. The clinical implications of distinguishing ON + M and isolated ON include differences in treatment regimen, avoidance of inappropriate use of medical resources, and differences in long-term outcomes.