Occipital neuralgia (ON) can flummox otolaryngologists especially when it follows mastoid surgery. The paroxysms of sharp, electrical pain originating from the occiput can extend along the posterior aspect of the scalp and even up to the mastoid. Although the aetiology of the pain is unknown, it can result from compression or trauma to one or more of the nerves in the distribution of the greater, lesser or third occipital nerve. The authors of this article are part of the multidisciplinary task force consisting of volunteer neurosurgeons and pain management specialists who formulated evidence based guidelines for the use of occipital nerve stimulation (ONS) for the treatment of patients with medically refractory ON . They reviewed the various treatment options for ON via a systematic literature search describing outcomes of interventions which include neuropathic agents, local anaesthetic / steroid / botulinum injection, dorsal root ganglionectomy, neurectomy, decompression, neurolysis, posterior rhizotomy and occipital nerve stimulation (ONS). Nine articles met their inclusion criteria, although none of the studies described in the articles included patient populations specific to medically refractory ON.
Based on the results of the data derived from the literature review, the task force recommends the use of ONS as a treatment option for patients with medically refractory ON.
They also acknowledge the need for prospective comparative studies to determine the usefulness of ONS in the long-term, as well as the difficulty in conducting double blind trials as the treatment of ONS depends on the producing paresthesia detected by the patient in the affected region.