A Pain in the Neck: Occipital Neuralgia vs. Cervicogenic Headache vs. Migrainous Cervicalgia

Occipital neuralgia, cervicogenic headache, and migraine are disorders that are commonly accompanied by neck pain. Although these disorders may present with similar features, coexist in the same patient, and have variable degrees of involvement of the C2 and C3 nerve roots, it is important to distinguish between these three entities, as the presumed diagnosis can lead to different diagnostic and therapeutic modalities.

Occipital neuralgia in particular is underdiagnosed, occipital nerve blocks are underutilized, and technical aspects that can influence the efficacy of occipital nerve blocks are not taught in most clinical training programs. There are often significant delays in referring refractory cases for interventional and surgical management. In patients presenting with headache and neck pain, making an accurate diagnosis is critical in order to optimize management. Without addressing comorbid diagnoses, patients tend to have suboptimal responses to both acute and preventative headache pharmacological therapies.