What is Occipital Neuralgia?
Occipital neuralgia is a distinct type of headache that can cause a throbbing, piercing, or electric shock pain, usually on one side of the head, that can travel from the upper neck to the scalp, behind the ears, and possibly behind the eyes and forehead. Some patients may also experience increased sensitivity to light and their scalp can be tender to the touch.
These symptoms are caused by the greater and lesser occipital nerves when they are compressed as they exit the spine where it meets the skull, or by tight muscles in this area. Typically, this is caused when the head is in a forward position leading to closing of the joint between the skull and spine and tightening of the muscles located in the upper neck and at the base of the head.
Most of the treatment strategies we will discuss include improving the space where these nerves exit by moving the head into a better position over the spine which increases the length of the spine. This also includes making sure the low back and the shoulder blades are in the correct position as well, typically, because when people first try to bring their head backward; they arch their back to compensate.
Included is a 10-minute exercise routine to address the issues mentioned previously. It involves improving the posture, use of a towel to stretch the neck where the nerves are compressed, and several basic neck and spinal stretches.
Occipital Neuralgia Exercises
Lumbar and Scapula Stabilization
The first exercise we will work on is to place the low back, or lumbar spine, in a neutral position. Start out in sitting, with your feet slightly ahead of your knees. You will then gently push into your heels engaging by engaging your hamstrings and glutes which will assist you in gently tilting your back and pelvis posteriorly. At the same time, you will also gently squeeze your shoulder blades toward each. This causes what I term the slinky effect, which helps to improve your posture and lengthen your spine. You can then repeat this for five breaths.
Towel Chin Tuck
Next is an exercise to help stretch your neck. You will take a towel and place the edge underneath your neck while in a seated position. The edge of the towel will not be on your head, but on the second cervical vertebrae underneath where your neck meets the base of the skull.
You will then take hold of the edge of the towel and pull gently forward while tucking your chin in. Simultaneously, you will gently press your heels into the ground and flatten your low back to further lengthen the spine.
Make sure when doing the chin tuck that you are not extending your neck by looking upward, but you are engaging the muscles in the front of the neck and getting into a “double chin” position. What this will do is to improve the space where the occipital nerves exit the spine at the levels of the first and second cervical vertebrae and the skull. You can repeat this for five breaths as well.
Towel Rotation Stretch
This next exercise is called a Cervical Snag. It is effective in improving the motion of her upper neck. You will begin in a seated position with your feet slightly past your knees. You will have a towel and place it again on the second cervical vertebrae below the skull.
Now, cross your left arm over your right arm on your chest and take the edge of the towel. Performing this simultaneously, you will gently pull down on the edge of the towel with the right hand while you pull the other end of the towel with your left arm at the level of the neck while rotating your head to the left.
Hold this position as you take in two deep breaths while lengthening your low back. Come back to the neutral position. You will now do the other side by crossing the right arm over the left arm. Taking each side of the towel, now pull down with the left arm while pulling forward with the right arm and rotate the head to the right. Hold for two breaths, and then relax back to a neutral position.
The towel works great but this strap was specifically designed for the exercises described above.
Rotator cuff exercise
Next, we will perform an exercise to help retrain the shoulder blades and rotator cuff muscles that are in the shoulder. In the same seated position, take the ends of a towel or Theraband while bending your elbows next to your side at a perpendicular angle to your shoulders.
Then, pull the ends away from each other while squeezing your shoulder blades together and engage the muscles below the notch in your shoulder blade called the Infraspinatus and Teres Minor. This is accomplished by rotating your arms backward. While doing this, make sure to flatten your low back and perform a chin tuck to bring the head over your shoulders instead of forward.
Do you need some resistance bands?
Upper Trapezius Stretch
The next exercise is a stretch for the Upper Trapezius. In the same seating position, and without arching your back, you with placing your left arm behind your back and take your right hand to the top of your head.
You will then gently bring your head to the right and hold until you feel a stretch in your upper shoulder. Then, repeat for the other side by placing your right arm behind your back and using the left hand to pull the head to the left.
Hold each side for two breaths. You can modify this stretch by placing by holding the side of a chair instead of placing your arm behind your back.
Levator Scapulae Stretch
Next, is a stretch for your Levator Scapulae. It is the same sequence as the Upper Trapezius stretch performed before, but now you bring your head down and nose pointing into the armpit opposite of the side you are stretching. You can hold each stretch for 2 breaths and then repeat on the other side.
Spinal Twist
These next exercises are to increase mobility in your thoracic spine, which is the middle and upper section of your back. The first is for rotation. Again, in the same seated position, take an inhale and on the exhale rotate to the right while pressing the left hand into the left thigh.
Then switch positions by rotating to the left and pressing the right hand into the right thigh while looking over your left shoulder. Come back to the neutral starting position.
Side Stretch
Now, while maintaining the elongated spine, reach down to your left side and side bend your back toward the left. Hold for two breaths and then return to the starting position. Then repeat on the right. Next, lift your right arm up and then bend to the left side to assist in stretching the right side of the body. Repeat for the right side.
Shoulder Rolls
Now, finish up by performing some shoulder rolls. In the same seated position, length your spine and gently roll your shoulders back by taking deep breaths. This concludes the regime for the Occipital Neuralgia exercise!
Check out what Hopkins Medicine has to say about Occipital Neuralgia. Please try physical therapy with an experienced clinician before trying the surgery they discuss as I have seen very little relief from it.