Occipital nerve entrapment

• Structure-based medical acupuncture for greater occipital neuralgia: a case report
• Involvement of the Ipsilateral Tongue, an Intraoral Structure of Referred Pain due to Entrapment of the Greater Occipital Nerve
• Accuracy of the Image Interpretation Capability of ChatGPT-4 Vision in Analysis of Hess Screen and Visual Field Abnormalities
• The roles of extracranial intravascular lesion, vasodilation-induced neural entrapment, and arteriolysis in migraine treatment
• Trans-obliquus inferior capitis course of the greater occipital nerve: A potential cause of occipital neuralgia?
• Challenges of Imaging the Greater Occipital Nerve Using Magnetic Resonance Imaging
• An anatomical analysis of the occipital nerve complex: an essential tool for the application of occipital nerve blocks
• Valleix's Sign

Greater occipital nerve (nerve of Arnold) is a sensory branch of C2.

Entrapment presents as occipital neuralgia: pain in occiput usually with a trigger point near the superior nuchal line. Pressure here reproduces pain radiating up along the back of the head towards the vertex.

More common in women.

1. trauma

a) direct trauma (including iatrogenic placement of suture through the nerve during surgical procedures, e.g., in closing a posterior fossa craniectomy)

b) following traumatic cervical extension ¹⁾ which may crush the C2 root and ganglion between the C1 arch and C2 lamina

c) fractures of the upper cervical spine

2. atlanto-axial subluxation (AAS) (e.g., in rheumatoid arthritis) or arthrosis

3. entrapment by hypertrophic C1–2 (epistrophic) ligament ²⁾.

4. neuromas

5. arthritis of the C2–3 zygapophyseal joint

1. headache

a) may be mimicked by a migraine headache

b) may be part of muscle contraction(tension)headache

2. myofascial pain: the pain may be widely separated from the trigger point

3. vertebrobasilar disease including aneurysm and SAH

4. cervical spondylosis

5. pain from Chiari I malformation.

Occipital nerve entrapment treatment.

A rare case of referred pain in the trigeminal nerve distribution caused by entrapment of the greater occipital nerve (GON). Notably, the pain extended to the ipsilateral tongue, an unusual intraoral involvement. GON entrapment can lead to sensitization in secondary nociceptive neurons within the trigeminocervical complex (TCC), which receives signals from both trigeminal and occipital nerves, causing referred facial pain. A 55-year-old female presented with chronic left temporo-occipital pain, along with pain in her left periorbital area, ear canal, gum, and a 20-year history of atypical facial pain on her left tongue and lower lip. Following GON decompression, her temporo-occipital pain and facial symptoms improved, with a significant reduction in burning pain on her tongue and resolution of lip tingling. The TCC, comprising convergent inputs from trigeminal and occipital nerves, is the anatomical basis of referred craniofacial pain. Chronic GON entrapment can sensitize second-order neurons in the TCC and medullary dorsal horn, explaining this unusual referred pain to the intraoral structures ³⁾.