Occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.
References
[1]
Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 33, 629- 808.
[2]
Evans, R.W. (2014) Posttraumatic Headaches in Civilians, Soldiers, and Athletes. Neurologic Clinics, 32, 283-303. http://dx.doi.org/10.1016/j.ncl.2013.11.010
[3]
Ruiz, M., Pedraza, M.I., de la Cruz, C., Barón, J., Muñoz, I., Rodríguez, C., Celorrio, M., Mulero, P., Herrero, S. and Guerrero, A.L. (2014) Headache in the Elderly: Characteristics in a Series of 262 Patients. Neurologia, 29, 321-326.
http://dx.doi.org/10.1016/j.nrl.2013.07.007
[4]
Gautschi, O.P., Payer. M., Corniola, M.V., Smoll, N.R., Schaller, K. and Tessitore, E. (2014) Clinically Relevant Complications Related to Posterior Atlanto-Axial Fixation in Atlanto- Axial Instability and Their Management. Clinical Neurology & Neurosurgery, 123, 131-135.
http://dx.doi.org/10.1016/j.clineuro.2014.05.020
[5]
Shimizu, S., Oka, H., Osawa, S., et al. (2007) Can Proximity of the Occipital Artery to the Greater Occipital Nerve act as a Cause of Idiopathic Greater Occipital Neuralgia? An Anatomical and Histological Evaluation of the Artery-Nerve Relationship. Plastic and Reconstructive Surgery, 119, 2029-2034, discussion 2035-2036.
http://dx.doi.org/10.1097/01.prs.0000260588.33902.23
[6]
Kihara, T. and Shimohama, S. (2016) Occipital Neuralgia Evoked by Facial Herpes Zoster Infection. Headache, 46, 1590-1591. http://dx.doi.org/10.1111/j.1526-4610.2006.00616_2.x
[7]
Sweet, J.A., Mitchell, L.S., Narouze, S., Sharan, A.D., Falowski, S.M., Schwalb, J.M., Machado, A., Rosenow, J.M., Petersen, E.A., Hayek, S.M., Arle, J.E. and Pilitsis, J.G. (2015) Occipital Nerve Stimulation for the Treatment of Patients With Medically Refractory Occipital Neuralgia: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline. Neurosurgery, 77, 332-341.
[8]
Manolitsis, N. and Elahi, F. (2014)Pulsed Radiofrequency for Occipital Neuralgia. Pain Physician, 17, E709-E717.
[9]
Kim, C.H., Hu, W., Gao, J., Dragan, K., Whealton, T. and Julian, C. (2015) Cryoablation for the Treatment of Occipital-Neuralgia. Pain Physician, 18, E363-E368.
[10]
Dodick, D.W., Turkel, C.C.,DeGryse, R.E., Aurora, S.K., Silberstein, S.D., Lipton, R.B., Diener, H.C. and Brin, M.F., PREEMPT Chronic Migraine Study Group (2010) Onabotulinumtoxin A for Treatment of Chronic Migraine: Pooled Results from the Double-Blind, Randomized, Placebo-Controlled Phases of the PREEMPT Clinical Program. Headache, 50, 921-936. http://dx.doi.org/10.1111/j.1526-4610.2010.01678.x
[11]
Francisco, G.E., Tan, H. and Green, M. (2012) Do Botulinum Toxins Have a Role in the Management of Neuropathic pain?: A Focused Review. American Journal of Physical Medicine & Rehabilitation, 91, 899-909. http://dx.doi.org/10.1097/PHM.0b013e31825a134b
[12]
Matak, I., Bach-Rojecky, L., Filipović, B. and Lacković, Z. (2011) Behavioral and Immunohistochemical Evidence for Central Antinociceptive Activity of OnabotulinumtoxinA. Neuroscience, 186, 201-207. http://dx.doi.org/10.1016/j.neuroscience.2011.04.026
[13]
Brown, E.A., Schütz, S.G. and Simpson, D.M. (2014)Botulinum Toxin for Neuropathic Pain and Spasticity: An Overview. Pain Management, 4, 129-151.
http://dx.doi.org/10.2217/pmt.13.75
[14]
Narouze, S. and Souzdalnitski, D. (2013) Occipital Nerve Entrapment within the Semispinalis Capitis Muscle Diagnosed with Ultrasound. Cephalalgia, 33, 1358-1359.
http://dx.doi.org/10.1177/0333102413492912
[15]
Volcy, M., Tepper, S.J., Rapoport, A.M., Sheftell, F.D. and Bigal, M.E. (2006) Botulinum Toxin A for the Treatment of Greater Occipital Neuralgia and Trigeminal Neuralgia: A Case Report with Pathophysiological Considerations. Cephalalgia, 26, 336-340.
http://dx.doi.org/10.1111/j.1468-2982.2005.00959.x
[16]
Siefferman, J. and Khelemsky, Y. (2015) Occipital Neuralgia after Hair Transplantation and Its Treatment. Case Reports in Neurological Medicine, 2015, Article ID: 428413.
http://dx.doi.org/10.1155/2015/428413
[17]
Alshadwi, A., Nadershah, M. and Osborn, T. (2015) Therapeutic Applications of Botulinum Neurotoxins in Head and Neck Disorders. The Saudi Dental Journal, 27, 3-11.
http://dx.doi.org/10.1016/j.sdentj.2014.10.001
[18]
Lecouflet, M., Leux, C., Fenot, M., Célerier, P. and Maillard, H. (2014) Duration of Efficacy Increases with the Repetition of Botulinum Toxin A Injections in Primary Palmar Hyperhidrosis: A Study of 28 Patients. Journal of the American Academy of Dematology, 70, 1083-1087. http://dx.doi.org/10.1016/j.jaad.2013.12.035
