Occipital neuralgia in lung carcinoma: A rare clinical scenario case report

www.onk.ns.ac.rs/Archive • Volume 24 • Issue 1 • 2018 INTRODUCTION Occipital Neuralgia (ON) is characterised by sharp shooting pain arising in the sensory distribution of occipital nerves. Owing to be an uncommon diagnosis and at the same time due to overlap in criteria with more common neuralgias, its incidence and prevalence is rarely reported (1). A study in the Dutch general population reported a relatively low incidence of 3.2 per 100.000 (2). Reported etiology for precipitation of ON can be divided in to vascular, neurogenic, muscular, and osteogenic causes. The pathophysiology of occipital neuralgia is yet to be specified. The prevalent hypothesis is that it results from injury to the C2-C3 nerve roots and/or occipital nerves through various mechanisms such as vertebral instability, trauma, inflammation, entrapment etc. The onset of pain in occipital neuralgia is usually acute. It is described in various ways stabbing / shooting / electric shock like that starts in the nuchal region and spreads towards vertex. The episode may start spontaneously or precipitate by factors such as movement, combing of hair, exposure to cold etc. On palpation, the occipital nerve trunks may reveal local tenderness. Percussion over occipital nerve often reproduces the distribution of pain (Tinel’s Sign)(1). Diagnosis of ON is achieved with the help of above mentioned clinical manifestations. Cervicogenic headache, Trigeminal neuralgia and referred occipital pain may mimic clinical features of ON and need to be ruled out.