후두신경통의 진단과 치료: 큰뒤통수신경 포착증후군을 중심으로

손병철 대한의사협회 2023 대한의사협회지 Vol.66 No.1

Background: Occipital neuralgia is defined as paroxysmal shooting, or stabbing pain in the posterior part of the scalp, in the distribution of the greater and lesser occipital nerves. Occipital neuralgia may present only as an intermittent stabbing pain, but different opinions exist on its cause and diagnostic criteria. Current Concepts: According to the latest version of headache classification, only paroxysmal stabbing pain is included in the diagnostic criteria, and persistent aching pain is excluded. Pain intensity was also limited to severe cases. It has therefore become difficult to classify existing occipital neuralgia, whose main symptom is persistent pain rather than paroxysmal stabbing pain. Occipital neuralgia is classified as either idiopathic or secondary. Secondary occipital neuralgia is caused by structural lesions innervating the trigeminocervical complex (TCC) in the upper spinal cord, the dorsal root of second cervical cord, and the greater occipital nerve (GON). Discussion and Conclusion: Although idiopathic occipital neuralgia has no cause, the entrapment of the GON in the tendinous aponeurotic attachment of the trapezius muscle at the superior nuchal line has recently been proposed as an etiology. Chronic, irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the TCC receiving convergent input from trigeminal and occipital structures. TCC sensitization induces referred pain in the facial trigeminal area.

Intractable Occipital Neuralgia Caused by an Entrapment in the Semispinalis Capitis

Son, Byung-Chul,Kim, Deok-Ryeong,Lee, Sang-Won The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.3

Occipital neuralgia is a rare pain syndrome characterized by periodic lancinating pain involving the occipital nerve complex. We present a unique case of entrapment of the greater occipital nerve (GON) within the semispinalis capitis, which was thought to be the cause of occipital neuralgia. A 66-year-old woman with refractory left occipital neuralgia revealed an abnormally low-loop of the left posterior inferior cerebellar artery on the magnetic resonance imaging, suggesting possible vascular compression of the upper cervical roots. During exploration, however, the GON was found to be entrapped at the perforation site of the semispinalis capitis. There was no other compression of the GON or of C1 and C2 dorsal roots in their intracranial course. Postoperatively, the patient experienced almost complete relief of typical neuralgic pain. Although occipital neuralgia has been reported to occur by stretching of the GON by inferior oblique muscle or C1-C2 arthrosis, peripheral compression in the transmuscular course of the GON in the semispinalis capitis as a cause of refractory occipital neuralgia has not been reported and this should be considered when assessing surgical options for refractory occipital neuralgia.

Clinical Outcomes of Pulsed Radiofrequency Neuromodulation for the Treatment of Occipital Neuralgia

Choi, Hyuk-Jai,Oh, In-Ho,Choi, Seok-Keun,Lim, Young-Jin The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.5

Objective : Occipital neuralgia is characterized by paroxysmal jabbing pain in the dermatomes of the greater or lesser occipital nerves caused by irritation of these nerves. Although several therapies have been reported, they have only temporary therapeutic effects. We report the results of pulsed radiofrequency treatment of the occipital nerve, which was used to treat occipital neuralgia. Methods : Patients were diagnosed with occipital neuralgia according to the International Classification of Headache Disorders classification criteria. We performed pulsed radiofrequency neuromodulation when patients presented with clinical findings suggestive occipital neuralgia with positive diagnostic block of the occipital nerves with local anesthetics. Patients were analyzed according to age, duration of symptoms, surgical results, complications and recurrence. Pain was measured every month after the procedure using the visual analog and total pain indexes. Results : From 2010, ten patients were included in the study. The mean age was 52 years (34-70 years). The mean follow-up period was 7.5 months (6-10 months). Mean Visual Analog Scale and mean total pain index scores declined by 6.1 units and 192.1 units, respectively, during the follow-up period. No complications were reported. Conclusion : Pulsed radiofrequency neuromodulation of the occipital nerve is an effective treatment for occipital neuralgia. Further controlled prospective studies are necessary to evaluate the exact effects and long-term outcomes of this treatment method.

후두신경 영역 침치료로 호전된 후두신경통 증례 1례

김민화,남이랑,김마리아,구기범,이세연,권정남,이인,최준용,윤영주,김소연,한창우,박소정,홍진우 대한한방내과학회 2023 大韓韓方內科學會誌 Vol.44 No.6

This case report presents the effectiveness of Korean medicine in the treatment of occipital neuralgia. The patient with occipital neuralgia was treated with acupuncture. Acupuncture treatment was administered to the occipital nerve area, which is commonly used in occipital nerve blocks by western medicine doctors. The severity of the symptoms was assessed daily using the Numerical Rating Scale (NRS) score of pain. The patient received outpatient treatment a total of 7 times, and only received acupuncture treatment each time. According to the patient, his symptoms decreased by about 90% two days after acupuncture treatment, and the frequency and duration of the symptoms also decreased. Seven days after all acupuncture treatments, the severity of pain was reduced from NRS 6 to NRS 0. The findings of this case report suggest that treatment with Korean medicine can be an effective option for treating occipital neuralgia. Acupuncture can be a good treatment method for occipital neuralgia, along with western drug treatment and occipital nerve block.

Intrathecal Morphine Infusion for Trigeminal Deafferentation Pain Following Percutaneous Intervention for Unexplained Facial Pain: A Case Report

Byung-Chul Son 대한신경손상학회 2022 Korean Journal of Neurotrauma Vol.18 No.1

Chronic pain in painful post-traumatic trigeminal neuropathy, formerly called trigeminal deafferentation pain (TDP) or anesthesia dolorosa, is virtually incurable neuropathic pain. In severe cases, no effective method has yet been established. A 58-year-old woman presented with chronic dysesthetic pain in the right side of her face that had persisted for 8 years. It was caused by percutaneous balloon compression for an unexplained, persistent right gingival pain. The TDP did not respond to any medications or radiosurgery. Considering the typical occipital neuralgia that occurred later, the incomprehensible gum pain was interpreted as referred trigeminal pain from occipital neuralgia. Decompression of the greater occipital nerve improved occipital neuralgia; however, TDP did not respond to internal neurolysis or invasive brain stimulation. The last attempt was made to administer an intrathecal opioid because of pain sufficiently severe to cause suicidal ideation. Trial administration of intrathecal opioids had some effect on pain relief. Although incomplete, the effects of intrathecal morphine infusion were maintained up to 1 year later. Invasive neurosurgical interventions should be cautiously performed for continuous pain in persistent idiopathic facial pain and referred facial pain cases that do not show typical neuralgic pain in primary trigeminal neuralgia because of the risk of TDP.

초음파 유도 하 자하거 약침치료로 호전된 후두신경통 환자 1례에 대한 증례보고

홍진기(Jin Gi Hong),선정흠(Jung Hum Sun),하동현(Dong Hyon Ha),김진현(Jin Hyun Kim),서민조(Min Jo Seo),선민지(Min Ji Sun),유성재(Sung Jae Yoo) 대한스포츠한의학회 2023 대한스포츠한의학회지 Vol.23 No.1

The Effectiveness and Safety of Acupuncture on Occipital Neuralgia: A Study Protocol for Systematic Review and/or Meta-Analysis

Moon Jeong-Hyun,Park Gyoungeun,Jang Jung Eun,Jo Hyo-Rim,Park Seo-Hyun,Sung Won-Suk,Kim Yongjoo,Yoon-Jae Lee,Lee Seung Deok,Kim Eun-Jung 대한침구의학회 2023 대한침구의학회지 Vol.40 No.3

Background: Occipital neuralgia (ON) is an established risk factor for headaches in the posterior cervical region. Several conservative treatments by nerve decompression and pain relief are available for ON, but these treatments have limitations. Acupuncture treatment, which is known to demonstrate analgesic effects, involves various stimulation methods, and several studies have reported their clinical benefit. No recent systematic review (SR) has compared each acupuncture type for ON treatment. Thus, this SR aims to investigate the clinical effectiveness of each acupuncture type for treating ON. Methods: We will identify relevant studies using electronic databases, including EMBASE, MEDLINE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Korean Studies Information Service System (KISS), Korean Medical Database, KoreaMed, and National Digital Science Library (NDSL) from the inception until August 2023. The primary outcome will include the numerical change of pain symptoms (visual analog scale and numerical rating scale) and effective rate. Safety and secondary outcomes will include adverse events and quality of life. We will compare the conservative treatment with the acupuncture treatment using network meta-analysis. The Cochrane Collaboration “risk of bias” tools will be used to assess the quality of included trials. The Grades of Recommendation, Assessment, Development, and Evaluation will be used to examine the evidence level. Conclusion: This study will provide clinical evidence of several acupuncture types for ON and help clinicians decide on the best.

Case Report : A Case of Occipital Neuralgia in the Greater and Lesser Occipital Nerves Treated with Neurectomy by Using Transcranial Doppler Sonography: Technical Aspects

( Sang Jin Jung ),( Seong Keun Moon ),( Tae Young Kim ),( Ki Seong Eom ) 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.1

Occipital neuralgia is usually defined as paroxysmal stabbing pain in the greater or lesser occipital nerve (GON or LON) distribution. In occipital neuralgia patients, surgical considerations are carefully taken into account if medical management is ineffective. However, identification of the occipital artery by palpation in patients with thick necks or small occipital arteries can be technically difficult. Therefore, we established a new technique using transcranial Doppler (TCD) sonography for more accurate and rapid identification. The patient was a 64-year-old man who had undergone C1-C3 screw fixation and presented with intractable stabbing pain in the bilateral GON and LON distributions. In cases in which pain management was performed using medication, physical therapy, nerve block, or radiofrequency thermocoagulation, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed occipital neurectomy of the bilateral GON and LON by using TCD sonography, which helped detect the greater occipital artery easily. After the operation, the patient`s headache disappeared gradually, although he had discontinued all medication except antidepressants. We believe that this new technique of occipital neurectomy via a small skin incision performed using TCD sonography is easy and reliable, has a short operative time, and provides rapid pain relief. (Korean J Pain 2011; 24: 48-52)

Fluoroscopy and Sonographic Guided Injection of Obliquus Capitis Inferior Muscle in an Intractable Occipital Neuralgia

Kim, Ok-Sun,Jeong, Seung-Min,Ro, Ji-Young,Kim, Duck-Kyoung,Koh, Young-Cho,Ko, Young-Sin,Lim, So-Dug,Shin, Hwa-Yong,Kim, Hae-Kyoung The Korean Pain Society 2010 The Korean Journal of Pain Vol.23 No.1

Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles.

A Case of Occipital Neuralgia in the Greater and Lesser Occipital Nerves Treated with Neurectomy by Using Transcranial Doppler Sonography: Technical Aspects

Jung, Sang-Jin,Moon, Seong-Keun,Kim, Tae-Young,Eom, Ki-Seong The Korean Pain Society 2011 The Korean Journal of Pain Vol.24 No.1

Occipital neuralgia is usually defined as paroxysmal stabbing pain in the greater or lesser occipital nerve (GON or LON) distribution. In occipital neuralgia patients, surgical considerations are carefully taken into account if medical management is ineffective. However, identification of the occipital artery by palpation in patients with thick necks or small occipital arteries can be technically difficult. Therefore, we established a new technique using transcranial Doppler (TCD) sonography for more accurate and rapid identification. The patient was a 64-year-old man who had undergone C1-C3 screw fixation and presented with intractable stabbing pain in the bilateral GON and LON distributions. In cases in which pain management was performed using medication, physical therapy, nerve block, or radiofrequency thermocoagulation, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed occipital neurectomy of the bilateral GON and LON by using TCD sonography, which helped detect the greater occipital artery easily. After the operation, the patient’s headache disappeared gradually, although he had discontinued all medication except antidepressants. We believe that this new technique of occipital neurectomy via a small skin incision performed using TCD sonography is easy and reliable, has a short operative time, and provides rapid pain relief.