American Society for Peripheral Nerve

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Outcomes of Surgical Treatment for Occipital Neuralgia Sports Injury vs Blunt Trauma
Karan Chopra, MD; Robin S Yang, MD; Eric H Williams, MD; A. Lee Dellon, MD, PhD
Johns Hopkins, Baltimore, MD

Background: Occipital neuralgia is characterized by paroxysmal headaches of the posterior scalp. Mechanism of injury causing this headache syndrome may be sports related or involve motor vehicle collision. These debilitating symptoms can be associated with a decreased quality of life. The authors aimed to characterize whether mechanism of injury was correlated with outcomes after surgical decompression in the management of occipital neuralgia.

Methods: A retrospective chart review identified 121 consecutive patients who underwent bilateral surgical neurolysis of the greater occipital nerve and resection of the lesser and third occipital nerves. Preoperative and postoperative visual analogue scale (VAS) pain scores and medication usage were measures as analogs of quality of life improvement.

Results: Of 121 patients, 71% were Female (n=86), 33.9% presented after sports related injuries (n=41), 37.1% presented after Motor Vehicle Collision (n=45), and 28.9% after blunt trauma (n=35). The overall mean follow-up time was 6 months. The subjects in the sports related injury cohort experienced an absolute decrease of 7.1 on the VAS as compared to 5.8 in the non-sports injury group (p<0.05). Medication usage in the sports related group decreased by an average of 69.4% compared to 55.7% in the non-sports injury group (p>0.05). Pain scores and medication usage did not increase in any patients. There were no major complications.

Conclusion: Surgical treatment is a safe and effective technique in patients with post-traumatic occipital neuralgia. Although this treatment modality is associated with improved VAS in both groups, sports-related injury patients may experience greater benefit from this operation.

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