Occipital neuralgia is the general term for the greater occipital nerve, the lesser occipital nerve, the inferior occipital nerve, and the 3rd occipital neuralgia. Broadly speaking, occipital refers to the distribution area of four pairs of occipital nerves, i.e., below the parietal node, behind the root of the ear on both sides, and between the connecting lines of the horizontal backward of the downward inclination angle; narrowly speaking, occipital refers to the squamous part of the occipital bone. The lesser occipital nerve is a branch of the cervical plexus, purely sensory, and is the anterior branch of the 2nd and 3rd cervical nerves, with sensory components mainly distributed in the mastoid region and the skin of the lateral occipital region; the inferior occipital nerve is a branch of the lst cervical nerve, mainly motor components, but also a small amount of sensory components.
The sensory component innervates the skin of the upper part of the collar and the lower posterior part of the head; the greater occipital nerve is a posterior branch of the 2nd cervical nerve, mixed, with mainly sensory components and a small amount of motor components. The sensory component is distributed over the skin from the superior collar line to the top of the head. The 3rd occipital nerve is a posterior branch of the 3rd occipitocervical nerve, mixed in nature, with sensory components distributed in the skin on both sides of the midline of the occipital region. According to the thickness and distribution of the nerve, the major occipital nerve, the minor occipital nerve, the 3rd occipital nerve and the inferior occipital nerve are in descending order of magnitude.
Clinically, occipital neuralgia is second only to vascular headache and functional headache, and can also involve the small occipital nerve and the 3rd nerve.
1. Etiology
Occipital neuralgia can be divided into primary occipital neuralgia and secondary occipital neuralgia. Primary occipital neuralgia occurs mostly in young adults, and before the onset of the disease, Richard has triggers such as cold, exertion, humidity, and poor sleep posture. It is most commonly secondary to upper respiratory tract infection. Some scholars believe that it is a nonspecific infection inflammation or toxic neuritis. For example, upper respiratory tract infection, influenza, malaria, rheumatism, diabetes, thyroid disease or alcoholism, lead poisoning, etc.
The etiology of secondary occipital neuralgia includes.
(l) cervical spine disease: cervical spine osteophytes are the most common cause. A few can be cervical spine tuberculosis, rheumatoid spondylitis or metastatic cancer.
(2) Intraspinal lesions: spinal cord tumors in the upper cervical segment, tumors in the antiforaminal area, adhesive spinal arachnoiditis, and spinal cavernous disease.
(3) Atlanto-occipital congenital malformation: skull base depression, foramen magnum stenosis, atlanto-occipital fusion, atlanto-axial dislocation, incomplete separation of upper cervical vertebrae (fusion), subungual tonsillar defect, etc.
(4) Injury: suboccipital joint ligament injury, atlantoaxial arch fracture, atlantoaxial push subluxation 1 cervical muscle injury, etc.
2, prevention of occipital neuralgia can take the following measures.
(1) Etiological prevention and control: avoiding and preventing systemic diseases, such as infection, diabetes, uremia, rheumatic fever, poisoning and other primary diseases, can reduce the chance of occipital neuralgia; secondly, preventing and avoiding secondary factors that cause occipital neuralgia, such as cervical tuberculosis, cervical spondylosis, myofibrosis, local infection and trauma. In addition, in order to improve the patient’s ability to prevent diseases, it is better to read or listen to some scientific knowledge about health and health, which is undoubtedly beneficial. Doing prevention first is better than treatment.
(2) Reduce occipital stimulation: high and hard pillows should be avoided, choose pillows with loose and comfortable, hats should not be too tight, reduce local stimulation as much as possible, and reduce the triggering factors of occipital neuralgia, such as preventing cold, moisture and fatigue.
3.Diagnosis
(1) There is often a history of cold, infection or “falling pillow” before the disease.
(2) Acute or subacute onset, manifested as stabbing pain, drilling pain or throbbing pain in the occipital neck on one side or both sides.
(3) Sensory hypersensitivity or hyperalgesia in the area innervated by the greater occipital nerve, and pressure pain at the outlet of the greater occipital nerve, which may radiate to the top of the ipsilateral head.
(4) In a few cases, there are still symptoms of cervical spondylosis or cervicothoracic radiculitis.
4.Treatment
Needle knife
(1) Position: the patient is in prone position with the lower jaw extended beyond the edge of the bed and inward as much as possible to fully expose the operative field.
(2) Fixation: search for pressure points under the external occipital ridge, between the superior and inferior occipital lines, and about 2.5 cm and 5 cm from the posterior median line, often touching the greater occipital nerve and the lesser occipital nerve, and fixing the most painful point at about 1 to 2 mm from the medial aspect of the nerve trunk.
(3) Orientation: the needle knife incision line is parallel to the longitudinal axis of the body, and the occipital nerve and occipital nerve travel in the same direction; the needle body is perpendicular to the occipital bone surface.
(4) Operation method.
The operating area is disinfected according to the surgical requirements, the cavity towel is laid, and the doctor wears a disposable cap, mask and sterile gloves. Choose Hanzhang brand Ⅰ type 4 needle knife (. The doctor’s left thumb presses the most painful point or hardened soft tissue, and the needle knife is pressed against the nail surface of the thumb, stabbing the subcutaneous tissue quickly at 1~2mm inside the painful point, slowly entering the needle to reach the occipital bone surface, longitudinally cutting the tense, contracted, adherent, thickened fascia and tendon fibers within about 0.5cm above and below the treatment point for 2~4 cuts; the depth of the needle knife lifting and inserting the cut, subject to the bone surface, the lifting and inserting amplitude does not exceed 0.3cm above and below. After longitudinal longitudinal incision and sparing, the needle body can be swung transversely to sparing transversely, and the needle hole is pressed for 5 min after the needle is released to prevent bleeding, and sterile gauze or band-aid is applied externally to the needle hole.
(5) Precautions.
①The occipital artery travels with the greater occipital nerve, but the occipital artery travels lateral to the greater occipital nerve. When palpating the occipital nerve compression point, the occipital artery can often be palpated. Therefore, when releasing the occipital nerve compression, the left thumb should push the occipital artery to the lateral side of the nail edge, and then the needle knife should pierce along the nail edge, which can effectively avoid injury to the occipital artery.
②When releasing the occipital nerve and occipital nerve, the patient’s reaction should be noted. If there is severe pain or electric sensation along the occipital nerve, the position of the needle knife should be changed and the operation should be performed again.