Approaches to Occipital Neuralgia Treatment: A Systematic Review and Case Examples

Area of Science:

• Neurology
• Pain Management
• Surgical Techniques

Background:

• Occipital neuralgia (ON) is a severe craniofacial pain condition affecting occipital nerves.
• Current ON management lacks a standardized approach, leading to variable clinical decisions.
• Existing interventions for ON are diverse, but structured diagnostic and treatment algorithms are scarce.

Purpose of the Study:

• To synthesize existing literature on occipital neuralgia management.
• To develop a structured, evidence-informed framework for ON diagnosis and treatment escalation.
• To address variability in clinical decision-making for ON.

Main Methods:

• Systematic review conducted following PRISMA 2020 guidelines.
• Searched PubMed, Embase, and Scopus databases (2000-2025).
• Assessed studies using AMSTAR 2, SANRA, and AGREE II tools; performed narrative synthesis.

Main Results:

• Included 14 studies (7 systematic reviews, 7 narrative reviews/guidelines).
• Common interventions include nerve blocks, decompression, neurectomy, and peripheral nerve stimulation.
• A novel framework integrates diagnostics (nerve blocks, imaging) and interventions (botulinum toxin, decompression vs. neurectomy) for guided management.

Conclusions:

• Highlights the need for unified, evidence-based decision-making in ON.
• Presents a structured, patient-specific framework for ON diagnosis, treatment, and escalation.
• Addresses critical gaps in current occipital neuralgia clinical practice.