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DRAFT - Pending Review
This plan requires physician review before clinical use.

Occipital Neuralgia

VERSION: 1.1 CREATED: February 8, 2026 REVISED: February 8, 2026 STATUS: Draft - Pending Review


DIAGNOSIS: Occipital Neuralgia

ICD-10: M54.81 (Occipital neuralgia)

CPT CODES: 85025 (CBC), 80048 (BMP), 86200 (CRP), 86140 (CRP quantitative), 85652 (ESR), 93000 (ECG), 70553 (MRI brain without and with contrast), 70551 (MRI brain without contrast), 72141 (MRI cervical spine without contrast), 72156 (MRI cervical spine without and with contrast), 70450 (CT head without contrast), 70498 (CTA neck), 70547 (MRA neck without contrast), 64405 (Greater occipital nerve block), 64402 (Lesser/third occipital nerve block), 64450 (Other peripheral nerve block), 64999 (Unlisted nerve block procedure), 64633 (Destruction by neurolytic agent, cervical/thoracic facet joint), 64635 (Destruction by neurolytic agent, paravertebral facet — radiofrequency), 64640 (Destruction by neurolytic agent, other peripheral nerve), 95907-95913 (Nerve conduction studies, 1-13+ studies), 95886 (Needle EMG, complete), 95867 (Needle EMG, cranial nerve innervated muscles), J0585 (OnabotulinumtoxinA injection), 64616 (Chemodenervation of muscle, neck), 63650 (Percutaneous implantation of neurostimulator electrode), 76942 (Ultrasound guidance for needle placement)

SYNONYMS: occipital neuralgia, Arnold neuralgia, Arnold's neuralgia, C2 neuralgia, greater occipital neuralgia, lesser occipital neuralgia, third occipital neuralgia, occipital nerve pain, suboccipital neuralgia, occipital headache, GON neuralgia, occipital nerve entrapment

SCOPE: Evaluation and management of occipital neuralgia in adults. Includes ICHD-3 diagnostic criteria, differentiation from migraine/tension-type/cervicogenic headache, diagnostic and therapeutic nerve blocks, pharmacotherapy, and interventional procedures. Covers ED acute management, inpatient evaluation for refractory cases, outpatient chronic management, and ICU considerations for severe refractory pain or post-procedural monitoring. Excludes primary headache disorders unless part of differential.


DEFINITIONS: - Occipital Neuralgia (ICHD-3 13.4): Unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp, in the distribution(s) of the greater, lesser, and/or third occipital nerves, sometimes accompanied by diminished sensation or dysesthesia in the affected area; commonly associated with tenderness over the affected nerve(s) - Greater Occipital Nerve (GON): Arises from the dorsal ramus of C2 (with contribution from C3); emerges between the obliquus capitis inferior and semispinalis capitis at the superior nuchal line, medial to the occipital artery - Lesser Occipital Nerve (LON): Arises from the ventral rami of C2-C3; courses along the posterior border of the sternocleidomastoid muscle - Third Occipital Nerve (TON): Arises from the dorsal ramus of C3; crosses the C2-C3 facet joint; innervates lower occipital region - Diagnostic Block Criteria (ICHD-3): Pain is temporarily relieved by local anesthetic block of the affected nerve(s); this is both diagnostic and part of the formal criteria - Cervicogenic Headache: Headache caused by a disorder of the cervical spine (C1-C3), distinguished from occipital neuralgia by its referred, non-neuralgic quality


PRIORITY KEY: STAT = Immediate | URGENT = Within hours | ROUTINE = Standard | EXT = Extended/atypical cases | - = Not applicable to this setting


1. LABORATORY WORKUP

1A. Core Labs (All Patients)

Test ED HOSP OPD ICU Rationale Target Finding
CBC with differential (CPT 85025) STAT ROUTINE ROUTINE STAT Baseline before interventional procedures; exclude infection Normal
BMP (CPT 80048) STAT ROUTINE ROUTINE STAT Baseline renal function before NSAIDs or procedural sedation Normal
ESR (CPT 85652) ROUTINE ROUTINE ROUTINE ROUTINE Giant cell arteritis screening if age >50; inflammatory etiology <20 mm/hr (age-adjusted)
CRP (CPT 86140) ROUTINE ROUTINE ROUTINE ROUTINE Inflammatory marker; complement ESR for GCA screening <3 mg/L

1B. Extended Labs (Based on Clinical Suspicion)

Test ED HOSP OPD ICU Rationale Target Finding
TSH ROUTINE ROUTINE ROUTINE - Thyroid dysfunction can contribute to pain syndromes Normal (0.4-4.0 mIU/L)
Glucose (fasting) or HbA1c ROUTINE ROUTINE ROUTINE ROUTINE Diabetes screening; diabetic neuropathy affecting occipital nerves FBG <126 mg/dL; HbA1c <6.5%
Vitamin B12 ROUTINE ROUTINE ROUTINE - Deficiency causes peripheral and cranial neuropathy >300 pg/mL
ANA - ROUTINE ROUTINE - Autoimmune etiology if clinical suspicion (systemic features) Negative
Rheumatoid factor - ROUTINE ROUTINE - RA with C1-C2 subluxation causing secondary occipital neuralgia Negative
Uric acid - - EXT - Gout with C1-C2 involvement (crowned dens syndrome) Normal

1C. Rare/Specialized Labs

Test ED HOSP OPD ICU Rationale Target Finding
Lyme antibodies (ELISA, Western blot) - ROUTINE EXT - Endemic areas; cranial neuropathy workup Negative
ACE level - ROUTINE EXT - Neurosarcoidosis with cranial nerve involvement Normal

2. DIAGNOSTIC IMAGING & STUDIES

2A. Essential Imaging (First-Line)

Study ED HOSP OPD ICU Timing Target Finding Contraindications
MRI cervical spine without/with contrast (CPT 72156) URGENT ROUTINE ROUTINE URGENT Initial workup Exclude C1-C2 pathology, disc herniation, Arnold-Chiari malformation, demyelinating lesion, cervical cord compression MRI-incompatible devices
MRI brain without/with contrast (CPT 70553) URGENT ROUTINE ROUTINE URGENT Initial workup if atypical features or red flags Exclude posterior fossa lesion, foramen magnum pathology, demyelinating disease MRI-incompatible devices

2B. Extended Imaging (Based on Clinical Suspicion)

Study ED HOSP OPD ICU Timing Target Finding Contraindications
CT cervical spine (C1-C2 focused) URGENT ROUTINE ROUTINE URGENT If bony pathology suspected; MRI contraindicated C1-C2 subluxation, fracture, degenerative changes, atlantoaxial instability None (contrast: renal disease, allergy)
CTA neck (CPT 70547) URGENT ROUTINE ROUTINE URGENT If vertebral artery dissection suspected (sudden onset, neck pain, neurologic signs) Patent vertebral arteries; no dissection Contrast allergy, renal insufficiency
Ultrasound of occipital nerve - ROUTINE ROUTINE - Guide nerve block; identify nerve swelling or entrapment Normal nerve caliber; identify nerve location None

2C. Rare/Specialized Studies

Study ED HOSP OPD ICU Timing Target Finding Contraindications
EMG/NCS of cervical paraspinals (CPT 95867) - ROUTINE EXT - Suspected cervical radiculopathy or motor involvement Normal or define radiculopathy Anticoagulation (relative)
Dynamic flexion-extension cervical X-rays - ROUTINE EXT - Suspected atlantoaxial instability (RA, Down syndrome) Normal alignment; no instability Acute trauma with unstable fracture
MR angiography brain - EXT EXT - Suspected dural AV fistula or vascular malformation in posterior fossa Normal vasculature MRI-incompatible devices

3. TREATMENT

3A. Acute/Emergent Treatment

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Greater occipital nerve (GON) block - diagnostic/therapeutic Local injection Acute occipital pain; diagnostic confirmation per ICHD-3 criteria 2-3 mL :: SC/deep :: once :: 2% lidocaine (2-3 mL) OR 0.5% bupivacaine (2-3 mL) injected at medial third of line between external occipital protuberance and mastoid process; aspirate before injection; may add methylprednisolone 40 mg or triamcinolone 20-40 mg Local infection, allergy to local anesthetic, coagulopathy Pain relief onset (lidocaine 5-10 min; bupivacaine 15-30 min); monitor for vasovagal reaction, hematoma STAT ROUTINE ROUTINE STAT
Lesser occipital nerve (LON) block Local injection Pain in LON distribution (lateral occiput, behind ear) 1-2 mL :: SC :: once :: 2% lidocaine (1-2 mL) OR 0.5% bupivacaine (1-2 mL) injected at posterior border of SCM, one-third distance from mastoid to occiput Local infection, allergy, coagulopathy Pain relief; vasovagal reaction STAT ROUTINE ROUTINE STAT
Ketorolac IV/IM Acute pain; anti-inflammatory 30 mg; 15 mg :: IV/IM :: once :: 30 mg IV/IM (15 mg if age >65, renal impairment, or weight <50 kg); max 5 days total NSAID use GI bleeding, renal failure, active peptic ulcer, CABG within 14 days Renal function, GI symptoms STAT ROUTINE - STAT
Naproxen PO Acute exacerbation; anti-inflammatory 500 mg :: PO :: BID :: 500 mg BID with food; max 1250 mg/day; limit 10-14 day course GI bleeding, renal failure, NSAID allergy, third trimester pregnancy GI symptoms, renal function, BP ROUTINE ROUTINE ROUTINE -
Cyclobenzaprine PO Cervical muscle spasm contributing to occipital nerve irritation 5 mg; 10 mg :: PO :: TID :: Start 5 mg TID; increase to 10 mg TID if needed; max 30 mg/day; short course (2-3 weeks) MAOIs within 14 days, hyperthyroidism, heart failure, arrhythmia Sedation, anticholinergic effects ROUTINE ROUTINE ROUTINE -
Acetaminophen PO/IV Mild-moderate acute pain; adjunct analgesic; NSAID contraindication 1000 mg :: PO/IV :: q6h :: 1000 mg PO q6h or 1000 mg IV q6h; max 4000 mg/day (2000 mg/day if hepatic impairment or chronic alcohol use) Severe hepatic impairment, allergy LFTs if prolonged use; hepatotoxicity signs STAT ROUTINE ROUTINE STAT

3B. First-Line Pharmacotherapy (Maintenance)

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Gabapentin PO First-line neuropathic pain; occipital neuralgia prophylaxis 300 mg; 600 mg; 900 mg :: PO :: TID :: Start 300 mg qHS; titrate by 300 mg q3-7d; target 900-1800 mg/day divided TID; max 3600 mg/day; adjust for renal function (CrCl-based) Hypersensitivity Sedation, dizziness, peripheral edema, renal function; suicidal ideation ROUTINE ROUTINE ROUTINE -
Pregabalin PO Neuropathic pain; alternative to gabapentin; faster titration 75 mg; 150 mg; 300 mg :: PO :: BID :: Start 75 mg BID; titrate by 75 mg q3-7d; target 150-300 mg BID; max 600 mg/day; adjust for renal function Hypersensitivity; angioedema history Sedation, dizziness, weight gain, peripheral edema, renal function ROUTINE ROUTINE ROUTINE -
Amitriptyline PO Neuropathic pain; coexisting insomnia or tension-type headache component 10 mg; 25 mg; 50 mg; 75 mg :: PO :: qHS :: Start 10-25 mg qHS; titrate by 10-25 mg q1-2wk; target 50-75 mg qHS; max 150 mg/day Recent MI, MAOIs within 14 days, acute angle-closure glaucoma ECG (baseline if >40 or cardiac risk), anticholinergic effects, sedation, weight gain, QTc - ROUTINE ROUTINE -
Nortriptyline PO Neuropathic pain; better tolerated than amitriptyline (less sedation, anticholinergic effects) 10 mg; 25 mg; 50 mg; 75 mg :: PO :: qHS :: Start 10-25 mg qHS; titrate by 10-25 mg q1-2wk; target 50-75 mg qHS; max 150 mg/day Recent MI, MAOIs within 14 days, acute angle-closure glaucoma ECG (baseline if >40 or cardiac risk), anticholinergic effects, QTc - ROUTINE ROUTINE -
Carbamazepine PO Sharp, lancinating occipital pain; neuropathic pain with paroxysmal character 100 mg; 200 mg; 400 mg :: PO :: BID :: Start 100 mg BID; titrate by 200 mg/day q3-7d; target 400-800 mg/day divided BID-TID; max 1200 mg/day HLA-B*1502 positive (SJS/TEN risk in Asian patients), bone marrow suppression, hepatic porphyria, MAOIs CBC q2wk x 2 months then q3months; LFTs, sodium, carbamazepine level (4-12 mcg/mL); HLA-B*1502 screen before starting - ROUTINE ROUTINE -
Baclofen PO Adjunctive for occipital neuralgia; lancinating component; muscle spasm 5 mg; 10 mg; 20 mg :: PO :: TID :: Start 5 mg TID; titrate by 5 mg/dose q3d; target 30-60 mg/day divided TID; max 80 mg/day; taper to discontinue (never stop abruptly) Hypersensitivity Sedation, dizziness, withdrawal seizures if abruptly discontinued; renal function - ROUTINE ROUTINE -

3C. Second-Line/Refractory Treatment

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
OnabotulinumtoxinA (Botox) Local injection Refractory occipital neuralgia; failed 2+ oral medications; coexisting chronic migraine 25-50 units :: IM :: q12wk :: 25-50 units total divided across GON and LON regions bilaterally; inject at occipital insertion points; onset 1-2 weeks; repeat q12 weeks Infection at injection site, known hypersensitivity, neuromuscular junction disorders (MG, Lambert-Eaton) Pain scores, neck weakness, dysphagia (rare with occipital injection) - - ROUTINE -
Lidocaine 5% patch Topical Localized occipital pain; adjunct to oral therapy 1-2 patches :: Topical :: daily :: Apply 1-2 patches to occipital region; 12 hours on / 12 hours off; cut to size as needed Allergy to amide-type local anesthetics Skin irritation - ROUTINE ROUTINE -
Capsaicin 0.075% cream Topical Adjunct for localized occipital pain; neuropathic pain Thin layer :: Topical :: TID-QID :: Apply thin layer to occipital region TID-QID; initial burning is expected (decreases over 1-2 weeks); wash hands after application; avoid eyes/mucous membranes Open wounds, broken skin Burning sensation (expected initially), skin irritation - - ROUTINE -
Duloxetine PO Neuropathic pain; coexisting depression or anxiety 30 mg; 60 mg :: PO :: daily :: Start 30 mg daily x 1 week; increase to 60 mg daily; max 120 mg/day Uncontrolled narrow-angle glaucoma, MAOIs within 14 days, severe hepatic impairment BP, hepatic function, serotonin syndrome signs, suicidal ideation - ROUTINE ROUTINE -
Oxcarbazepine PO Neuropathic pain; alternative to carbamazepine with fewer drug interactions 150 mg; 300 mg; 600 mg :: PO :: BID :: Start 150 mg BID; titrate by 300 mg/day q1wk; target 600-1200 mg/day divided BID; max 2400 mg/day Hypersensitivity to oxcarbazepine or carbamazepine Sodium q1-3 months (hyponatremia risk higher than carbamazepine); LFTs; CBC - ROUTINE ROUTINE -
Venlafaxine XR PO Neuropathic pain; coexisting depression or anxiety; alternative to duloxetine 37.5 mg; 75 mg; 150 mg :: PO :: daily :: Start 37.5 mg daily x 1 week; increase to 75 mg daily; target 75-150 mg daily; max 225 mg/day Uncontrolled hypertension, MAOIs within 14 days BP (dose-dependent hypertension), serotonin syndrome signs, suicidal ideation - ROUTINE ROUTINE -

3D. Interventional/Procedural Treatment

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
GON block with steroid (ultrasound-guided) (CPT 64405, 76942) Local injection Confirmed occipital neuralgia with positive diagnostic block; recurrent episodes 2-3 mL :: SC/deep :: q4-8wk :: 0.5% bupivacaine 2-3 mL + methylprednisolone 40 mg (or triamcinolone 40 mg); US-guided for precision; landmark: medial third of line from external occipital protuberance to mastoid process; repeat q4-8 weeks as needed (limit 3-4 steroid injections per year) Active infection, coagulopathy, allergy to injectate Pain scores, duration of relief, steroid side effects (skin atrophy, glucose elevation in diabetics) - ROUTINE ROUTINE -
C2 nerve root block (fluoroscopy-guided) Local injection Refractory to peripheral nerve blocks; suspected C2 root origin 1-2 mL :: Perineural :: once :: 0.5% bupivacaine 1-2 mL +/- dexamethasone 4 mg; fluoroscopy-guided with contrast confirmation; performed by interventional pain specialist or neuroradiologist Active infection, coagulopathy, vertebral artery anomaly Post-procedure neurologic exam; monitor for vertebral artery injury, spinal cord injury, high spinal block - ROUTINE ROUTINE -
Pulsed radiofrequency ablation (PRF) of GON or C2 dorsal root ganglion Percutaneous Refractory occipital neuralgia; positive diagnostic block but short-lived relief from repeated injections N/A :: Percutaneous :: once :: 42 degrees C, 120 seconds x 2-3 cycles; fluoroscopy or US-guided needle placement at GON or C2 DRG; performed by pain specialist; non-destructive (pulsed, not thermal) Active infection, coagulopathy, implanted cardiac device near field Post-procedure pain assessment; monitor for numbness, dysesthesia, infection - ROUTINE ROUTINE -
C1-C2 (atlantoaxial) facet joint injection Local injection Suspected C1-C2 facet-mediated pain contributing to occipital neuralgia 0.5-1 mL :: Intra-articular :: once :: 0.5% bupivacaine 0.5-1 mL + triamcinolone 20 mg; fluoroscopy-guided with contrast arthrogram; performed by interventional pain specialist Active infection, coagulopathy, vertebral artery anomaly Pain response; vertebral artery injury risk; infection - ROUTINE ROUTINE -
Occipital nerve stimulation (ONS) (CPT 63650) Implant Medically refractory occipital neuralgia; failed 3+ medication classes and interventional procedures; significant functional impairment N/A :: Subcutaneous :: continuous :: Percutaneous trial (5-7 days) first; if >50% pain relief, proceed to permanent implant; leads placed transversely across the occiput at C1 level; requires multidisciplinary evaluation and psychological screening Active infection, coagulopathy, inability to manage device, untreated psychiatric comorbidity Device function, lead migration, infection, battery life; pain scores; follow-up at 1, 3, 6, 12 months then annually - EXT EXT -

4. OTHER RECOMMENDATIONS

4A. Referrals & Consults

Recommendation ED HOSP OPD ICU Indication
Headache/pain specialist (neurology) ROUTINE ROUTINE ROUTINE ROUTINE Diagnostic uncertainty; refractory to initial treatment; consideration of interventional procedures
Interventional pain medicine - ROUTINE ROUTINE - Candidate for fluoroscopy/US-guided nerve blocks, PRF, or neurostimulation
Physical therapy (cervical spine focused) - ROUTINE ROUTINE - Cervical muscle dysfunction, postural contributors, myofascial trigger points
Neurosurgery - EXT EXT - Structural compression (Arnold-Chiari, posterior fossa lesion); consideration for occipital nerve decompression
Rheumatology - ROUTINE EXT - Suspected autoimmune etiology (RA with C1-C2 subluxation, lupus)
Psychiatry/psychology - ROUTINE ROUTINE - Chronic pain with coexisting depression, anxiety, or catastrophizing; pre-implant psychological evaluation for ONS
Ophthalmology - ROUTINE ROUTINE - Visual symptoms suggesting GCA; papilledema on fundoscopy; evaluate for secondary causes

4B. Patient Instructions

Recommendation ED HOSP OPD ICU Rationale
Avoid prolonged neck flexion (phone, computer) and sustained postures; take breaks every 30 minutes ROUTINE ROUTINE ROUTINE - Postural strain exacerbates occipital nerve irritation
Apply warm compresses to suboccipital region for 15-20 minutes, 3-4 times daily ROUTINE ROUTINE ROUTINE - Muscle relaxation; reduces spasm-related nerve compression
Perform gentle cervical stretching exercises as directed by physical therapy - ROUTINE ROUTINE - Reduces muscle tension; improves cervical mobility
Avoid tight headwear, helmets, or hairstyles that compress the occipital region ROUTINE ROUTINE ROUTINE - External compression is a known trigger for occipital neuralgia
Keep a headache diary recording frequency, severity (0-10), triggers, and medication use - ROUTINE ROUTINE - Tracks treatment response; identifies triggers and patterns
Return to ED immediately if sudden severe headache ("thunderclap"), fever, neck stiffness, vision changes, weakness, or numbness ROUTINE ROUTINE ROUTINE - Red flags for secondary causes (SAH, meningitis, vertebral artery dissection)
Take medications exactly as prescribed; do not abruptly stop gabapentin, pregabalin, carbamazepine, or baclofen ROUTINE ROUTINE ROUTINE - Abrupt discontinuation risks withdrawal seizures and rebound pain

4C. Lifestyle & Prevention

Recommendation ED HOSP OPD ICU Rationale
Complete ergonomic workstation assessment and modification - - ROUTINE - Reduces prolonged cervical strain; corrects forward head posture
Use cervical pillow and maintain neutral cervical alignment during sleep - ROUTINE ROUTINE - Improper sleep position compresses occipital nerves; maintain neutral cervical alignment
Engage in stress reduction techniques (mindfulness, biofeedback, cognitive behavioral therapy) - - ROUTINE - Stress and muscle tension exacerbate occipital neuralgia; CBT shown effective for chronic pain
Maintain regular aerobic exercise (30 minutes, 5 days/week) - - ROUTINE - Central pain modulation; improves overall pain tolerance; reduces comorbid depression
Limit caffeine intake to <200 mg/day and avoid abrupt caffeine withdrawal - - ROUTINE - Caffeine withdrawal can trigger headache exacerbation; excessive use contributes to medication overuse

5. DIFFERENTIAL DIAGNOSIS

Alternative Diagnosis Key Distinguishing Features Tests to Differentiate
Migraine (with or without aura) Pulsating quality, unilateral frontotemporal predominance, photophobia/phonophobia, nausea/vomiting, aura; attacks 4-72 hours ICHD-3 criteria; migraine does not respond to occipital nerve block (or response is incidental due to overlap)
Tension-type headache Bilateral, pressing/tightening quality, mild-moderate intensity, no nausea; pericranial tenderness Clinical criteria; typically holocephalic rather than occipital; no lancinating quality
Cervicogenic headache Unilateral, non-throbbing; reduced cervical ROM; pain provoked by neck movement or sustained postures; referred from C1-C3 Diagnostic cervical medial branch block; MRI cervical spine; pain is referred (not neuralgic); does not follow specific nerve distribution
C2 radiculopathy Neck pain radiating to occiput; may have dermatomal sensory loss; motor weakness rare MRI cervical spine (C1-C2 pathology); EMG/NCS; C2 selective nerve root block
Arnold-Chiari malformation (Type I) Occipital headache provoked by Valsalva, cough, or straining; may have cerebellar signs, syringomyelia MRI brain and cervical spine (cerebellar tonsil descent >5 mm below foramen magnum)
Posterior fossa lesion (tumor, AVM) Progressive headache, worse in morning; nausea/vomiting; papilledema; cerebellar signs MRI brain with contrast; fundoscopic exam
Vertebral artery dissection Sudden severe occipital/neck pain; may have Horner syndrome, lateral medullary signs, stroke symptoms CTA neck; MRA with fat suppression; onset is acute/sudden
Giant cell arteritis (temporal arteritis) Age >50; jaw claudication, scalp tenderness, visual changes; elevated ESR/CRP; temporal artery tenderness ESR, CRP (markedly elevated); temporal artery biopsy; temporal artery ultrasound (halo sign)
Cluster headache Strictly unilateral periorbital/temporal pain; autonomic features (lacrimation, ptosis, rhinorrhea); attacks 15-180 min; circadian periodicity ICHD-3 criteria; autonomic features absent in occipital neuralgia; different pain distribution

6. MONITORING PARAMETERS

Parameter Frequency Target/Threshold Action if Abnormal ED HOSP OPD ICU
Pain scores (NRS 0-10) Every visit NRS reduction by 50% or to <4/10 Adjust medication dose; consider interventional procedure STAT Daily Every visit STAT
Nerve block response (duration/degree of relief) After each block >50% pain relief; duration >2 weeks If short-lived, consider PRF or repeat with steroid; if no response, reconsider diagnosis STAT ROUTINE ROUTINE STAT
CBC (if on carbamazepine) q2wk x 2 months, then q3 months Normal WBC and platelets Hold carbamazepine if WBC <3000 or ANC <1500 or platelets <100K; hematology referral - ROUTINE ROUTINE -
Sodium (if on carbamazepine or oxcarbazepine) q1-3 months >130 mEq/L Reduce dose or switch agent if hyponatremia - ROUTINE ROUTINE -
LFTs (if on carbamazepine) Baseline, q3-6 months Normal Reduce dose or discontinue if transaminases >3x ULN - ROUTINE ROUTINE -
Renal function (if on gabapentin/pregabalin) Baseline, annually Normal CrCl; dose-adjust if impaired Adjust gabapentin/pregabalin dose per CrCl - ROUTINE ROUTINE -
ECG (if on tricyclics) Baseline, after dose changes QTc <500 ms; no conduction delay Reduce dose or discontinue if QTc prolonged or new conduction abnormality - ROUTINE ROUTINE -
Headache frequency/severity diary Ongoing Decreasing frequency and severity over time Medication adjustment; consider interventional procedure if worsening ROUTINE ROUTINE Every visit -
Blood pressure (if on duloxetine or venlafaxine) Baseline, q1-3 months <140/90 mmHg Reduce dose or switch agent if sustained hypertension - ROUTINE ROUTINE -

7. DISPOSITION CRITERIA

Disposition Criteria
Discharge from ED Diagnosis confirmed by clinical features and/or positive diagnostic nerve block; pain controlled with oral medications; no red flags; outpatient follow-up arranged within 2-4 weeks
Admit to hospital Intractable pain despite ED nerve block and parenteral analgesics; need for IV medications or serial nerve blocks; diagnostic uncertainty requiring urgent imaging; suspected secondary cause (dissection, mass)
ICU admission Suspected vertebral artery dissection with neurologic deficits; post-procedural complication requiring close monitoring; hemodynamic instability related to pain crisis or anaphylaxis from procedural agents
Outpatient neurology/headache follow-up All patients with new diagnosis of occipital neuralgia; medication titration and monitoring; assessment of treatment response at 4-6 weeks
Interventional pain referral Failed 2+ oral medication trials at adequate doses; recurrent need for nerve blocks (>3 per year); candidate for PRF, botulinum toxin, or neurostimulation evaluation
Neurosurgery referral Structural lesion identified (Chiari malformation, posterior fossa mass, C1-C2 pathology requiring surgical intervention); occipital nerve decompression consideration
Primary care follow-up Medication management for stable patients; metabolic monitoring (labs for carbamazepine, gabapentin renal dosing); annual reassessment of treatment plan

8. EVIDENCE & REFERENCES

Recommendation Evidence Level Source
ICHD-3 diagnostic criteria for occipital neuralgia (13.4): pain in distribution of occipital nerves, tenderness over nerve, temporary relief with anesthetic block Expert consensus, Class III Headache Classification Committee of the IHS. Cephalalgia 2018
Greater occipital nerve block is both diagnostic and therapeutic for occipital neuralgia; positive response supports the diagnosis Class III, Level C Dougherty C. Curr Pain Headache Rep 2014
Gabapentin and pregabalin are effective for neuropathic pain including occipital neuralgia Class I (general neuropathic pain), extrapolated Finnerup NB et al. Lancet Neurol 2015
OnabotulinumtoxinA injection in occipital region reduces pain in refractory occipital neuralgia Class III-IV Choi I, Laurito CE. Curr Pain Headache Rep 2011
Pulsed radiofrequency of C2 dorsal root ganglion provides sustained relief in refractory occipital neuralgia Class III Vanderhoek MD et al. Anesth Pain Med 2013
Occipital nerve stimulation for medically intractable occipital neuralgia: systematic review shows moderate efficacy Class III, systematic review Sweet JA et al. Neurosurgery 2015
Tricyclic antidepressants (amitriptyline, nortriptyline) are effective for neuropathic pain; NNT approximately 3.6 Class I (general neuropathic pain), extrapolated Moore RA et al. Cochrane Database Syst Rev 2015
Carbamazepine is effective for paroxysmal neuralgic pain; first-line for trigeminal neuralgia, used for occipital neuralgia with lancinating character Class I (TN), extrapolated Di Stefano G et al. Expert Rev Neurother 2017
Ultrasound-guided occipital nerve blocks improve accuracy and efficacy compared to landmark technique Class II Shim JH et al. Korean J Anesthesiol 2011
Cervicogenic headache must be differentiated from occipital neuralgia; diagnostic cervical medial branch blocks are the gold standard Expert consensus, Class III Bogduk N, Govind J. Lancet Neurol 2009

NOTES

  • ICHD-3 diagnostic criteria require all of the following: (1) unilateral or bilateral pain in distribution of GON, LON, or TON; (2) pain has two of three: recurring paroxysmal attacks lasting seconds to minutes, severe intensity, shooting/stabbing/sharp quality; (3) tender to palpation over the affected nerve; (4) pain temporarily relieved by local anesthetic block
  • The greater occipital nerve block is the cornerstone of both diagnosis and initial treatment; a positive response (>50% relief) is required for definitive ICHD-3 diagnosis
  • GON landmark: palpate external occipital protuberance (EOP); the GON is approximately at the medial third of a line drawn from EOP to mastoid process; the occipital artery pulse may be used as an adjacent landmark
  • Occipital neuralgia frequently coexists with migraine; treat both conditions when present
  • Distinguish from cervicogenic headache: occipital neuralgia is neuralgic (paroxysmal, shooting), while cervicogenic headache is referred, dull, and provoked by neck movement
  • Red flags requiring urgent imaging: sudden onset, fever, weight loss, neurologic deficits, history of cancer, anticoagulation, trauma, age >50 with new headache
  • Avoid overuse of nerve blocks with steroid (limit 3-4 per year) due to risk of local tissue atrophy and systemic steroid effects
  • When starting carbamazepine, screen for HLA-B*1502 in patients of Asian descent (risk of Stevens-Johnson syndrome / toxic epidermal necrolysis)
  • Pulsed radiofrequency (42 degrees C) is preferred over conventional thermal radiofrequency (80 degrees C) for occipital nerves to avoid deafferentation pain and permanent numbness
  • Occipital nerve stimulation should be reserved for truly refractory patients after multidisciplinary evaluation including psychological assessment

CHANGE LOG

v1.1 (February 8, 2026) - [C1] Added ICU to frontmatter setting field (was ED, HOSP, OPD only) - [C2] Added ICU column to Section 4B (Patient Instructions) and 4C (Lifestyle) tables - [S1] Section 1A: Added ICU coverage (STAT/ROUTINE) for core labs (CBC, BMP, ESR, CRP) - [S2] Section 1B: Changed TSH, Glucose/HbA1c, Vitamin B12 from "-" to ROUTINE for ED where clinically applicable; added ANA/RF HOSP coverage - [S3] Section 1C: Added HOSP ROUTINE for Lyme antibodies and ACE level - [S4] Section 2A: Added ICU URGENT for MRI cervical spine and MRI brain (red flag presentations) - [S5] Section 2B: Added ICU URGENT for CT cervical spine and CTA neck; added OPD ROUTINE for CTA neck - [S6] Section 2C: Added HOSP ROUTINE for EMG/NCS and flexion-extension X-rays - [S7] Section 3A: Added ICU coverage (STAT) for GON block, LON block, and ketorolac; added acetaminophen as new acute treatment - [S8] Section 3B: Changed gabapentin and pregabalin ED from "-" to ROUTINE (can initiate in ED for discharge) - [S9] Section 3C: Added oxcarbazepine and venlafaxine XR as additional second-line options; added duloxetine HOSP ROUTINE - [S10] Section 4A: Added ED ROUTINE for headache/pain specialist; added ICU ROUTINE; added ophthalmology referral (7th referral) - [S11] Section 4A: Changed rheumatology HOSP from "-" to ROUTINE - [S12] Section 6: Added headache diary ED and HOSP coverage (ROUTINE); added blood pressure monitoring for SNRIs; updated sodium monitoring to include oxcarbazepine - [S13] Section 7: Added ICU admission criteria; enhanced discharge and follow-up criteria - [M1] Standardized structured dosing dose_options field across all medications (cleaned up formats) - [R1] Section 4B: Strengthened directive language; added medication compliance instruction (7th item) - [R2] Section 5: Added cluster headache to differential diagnosis (9th entry) - [R3] Updated SCOPE to include ICU considerations - Updated VERSION to 1.1

v1.0 (February 8, 2026) - Initial draft creation - ICHD-3 diagnostic criteria incorporated - Diagnostic and therapeutic nerve block protocols included (GON, LON, C2 root) - Pharmacotherapy: gabapentin, pregabalin, amitriptyline, nortriptyline, carbamazepine, baclofen - Interventional procedures: pulsed RF, ONS, C1-C2 facet injection - Differential diagnosis includes migraine, tension-type, cervicogenic, Chiari, GCA, dissection - 10 evidence references with PubMed links