What Is The Difference Between Migraine And Occipital Neuralgia?



What Is The Difference Between Migraine And Occipital Neuralgia?

I have had 3 epidurals over the last 8 years, the last one in June 09, after an MRI showed "moderate to severe" arthritis in my neck
vertabrae. I am 53 years old. My diagnosis is "occipital neuralgia" and my symptoms pretty much fit the migraine profile except for the auras. And I also used to have the prementrual migraines, so I think I am predisposed to them.

I have also had fibromyalgia for 20 years, and I believe much of the damage to my neck vertebrae is from constant muscle spasms in my neck and upper back constantly pulling them out of alignment. If I pick up anything weighing over about 7 pounds I almost always have a migraine
the next day. I was reading about the soldiers having migraines after minor head or neck injuries, and mine are caused by similiar problems. They really kicked in about 10 years ago.

I got my last nerve block (and the MRI) because I was having constant pain from a mucle spasm in the back of my neck, which is where I had
the epidural. Now, about 4 months later, I find it hasn't helped me as much as I had hoped. Now the pain and spasms are going AROUND the back
of my neck where I had the epidural, and up the sides of my neck into my jaw and head. I saw my rheumatologist last week and he gave me trigger point injections at the base of my neck on the sides for the spasms. I had immediate relief but only for a few days.

Once the spasms relax, then the migraine hits.
Pain meds do not work for me, but as I saw elsewhere on the migraine website, injections of keterolac can help. When I lived in VA and I
went to my doc with a migraine he would give me an injection of 60mg. of keterolac (Toradol) and it would help. You know people say there is no objective test to determine if someone is having severe pain, but I realized that every time I went in with the migraine my BP would shoot up to 160 over something, when normal was 110/70.

So what is the difference, if they both cause pain in the occipital nerve?



Welcome to MyMigraineConnection!

Migraine is a genetic neurological disease marked by episodes we generally call Migraine attacks. Migraine attacks can consist of up to four phases, and one Migraine attack can vary from the next in which phases you have. Only about 25% of Migraineurs ever experience the aura phase. You can read more about the phases of a Migraine attack and their potential symptoms in Anatomy of a Migraine.

Occipital neuralgia is a chronic pain disorder caused by irritation or injury to the occipital nerve located in the back of the scalp. Individuals with the disorder experience pain originating at the nape of the neck. The pain, often described as throbbing and migraine-like, spreads up and around the forehead and scalp. Occipital neuralgia can result from physical stress, trauma, or repeated contraction of the muscles of the neck.

As you can see and as you know for yourself, it can sometimes be difficult to tell if you're having a Migraine or if the problem is occipital neuralgia. However, Migraines can have symptoms that would be absent with occipitan neuralgia -- nausea, vomiting, sensitivity to sound, sensitivity to light, aura symptoms, and more.

Another difference is that Migraine abortive medications such as the triptans -- Imitrex, Maxalt, Zomig, etc. -- and ergotamines such as DHE-45 and Migranal nasal spray don't work for occipital neuralgia.

If you're having trouble telling the difference, and your doctor is unable to help, it may well be time to consult a Migraine and headache specialist. It's important to note that neurologists aren't necessarily Migraine and headache specialists. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.

I hope this helps.

Welcome again,


Answered by Teri Robert