What’s Causing Your Child’s Severe Headaches? It Could Be Occipital Neuralgia

If your child is having persistent headaches with pain they describe as shooting, stabbing or like an electric shock, it’s time to see a doctor. Although its symptoms might mimic migraines and other types of headaches, occipital neuralgia might be the cause.  

The good news is that occipital neuralgia (ON) is rare. Fewer than 3 in 100,000 people experience it every year, and it is thought to be even more rare in children. But because it is difficult to diagnose in children, many cases may not be reported.

What Is Occipital Neuralgia?

ON is a headache disorder that occurs when your child’s occipital nerves become inflamed with irritation or swelling. These nerves carry messages from your child’s brain through the scalp.

Occipital neuralgia causes a piercing or shock-like pain in the back of the head, upper neck and behind the ears or eyes. It may be felt on both sides of your child’s head or on just one side. These bouts of pain are sudden but usually short in duration — a few seconds to minutes — and can occur multiple times a day.

In addition to the headache, the condition may cause sensitivity to light and scalp tenderness. Children who experience ON also may have migraine headaches or other types of headaches.

Symptoms of Occipital Neuralgia

Your child is likely to describe the pain as severe and also shooting, stabbing, sharp or like an electric shock. Other symptoms, which can occur with or without head pain, include:

• Tenderness
• Numbness
• Decreased sensation

However, younger children may not be able to provide an accurate description of their pain location or severity, so all head pain should be reported to your child’s pediatrician.

Causes of Occipital Neuralgia

ON can affect your child at any age. It usually occurs after your child has experienced one of the following:

• Head trauma
• Upper spine tumors
• Posterior neck surgery
• An infection

That’s because ON can result from inflammation or entrapment of the upper cervical nerves or the greater occipital nerve. Once your child has this condition, it can be triggered by exposure to cold, moving their neck or brushing their hair.

Diagnosing Occipital Neuralgia

Diagnosing ON can be difficult because your child may be experiencing symptoms that also are characteristic of migraines and other headache disorders. Plus, there is not a single test to confirm occipital neuralgia. So the diagnosis primarily is made with a detailed clinical history, along with physical and neurological exams. A CT scan or MRI often is ordered so that your child’s doctor can rule out other causes of the pain.

Treating Occipital Neuralgia

Treatments focus on decreasing pain when your child has symptoms. A range of nonsurgical or surgical treatments can help. Your child’s doctor usually will first suggest nonsurgical treatments, such as massage, heat and physical therapy. They also may prescribe medications, such as anticonvulsants to treat seizures or other brain overactivity, muscle relaxants or nonsteroidal anti-inflammatory drugs (NSAIDs).

If these conservative measures do not bring relief, the doctor may recommend a nerve block, which is an injection of numbing medication and steroids, or botulinum toxin (Botox) injections to decrease inflammation.

If your child’s symptoms don’t improve after trying nonsurgical measures, surgical treatments may be an option. Occipital nerve stimulation involves putting electrodes on the occipital nerve to stop pain signals from reaching the brain. With spinal cord stimulation, electrodes are placed on your child’s spinal cord to block pain signals from reaching the brain.