Occipital
neuralgia is an extracranial
pain that may be confused with other
headaches. It can be attributed to multiple causes. The authors report the case of a 55-year-old woman suffering from right occipital
neuralgia secondary to
respiratory tract infection that began 6 days before the
pain started. The patient suffered from a sharp and
burning pain with paroxysms in the right occipital region and at the top of the right ear. Sensation was decreased in the affected area, and
hypersensitivity to touch and cold water was also noted. Tinel's sign was present, and
local anesthetic block produced
pain relief. The combination of
gabapentin and
amitriptyline did not provide significant
pain relief but led to marked adverse effects.
Carbamazepine (300 mg/d) was required for
pain control. A month later the patient appeared totally
pain-free. The treatment was continued for 3 months, and the patient remained
pain-free over a subsequent follow-up period of more than 6 months. Thus, in the case of occipital
pain, a careful assessment of symptoms and a thorough history are necessary to obtain the correct diagnosis and to choose the appropriate treatment plan.