29. Onset Of Occipital Neuralgia Following Head and Neck Trauma

PURPOSE: Previous studies have shown that occipital neuralgia (ON) is associated with head and neck trauma. The trapezius fascia has been found to be fibrotic and thickened surrounding the occipital nerves, further supporting this clinical association. Posttraumatic headaches are defined as a secondary headache within 7 days following trauma or after recovering ability to report pain. However, the timing of symptom onset and development of ON following trauma is unknown. This study aims to determine the onset of ON following trauma and the types of traumas that may predispose to ON. METHODS: Subjects who underwent screening for nerve decompression surgery were evaluated for ON. History of head or neck injury, timing of head pain following injury, and mechanism of injury were prospectively collected in a subgroup of patients with ON (n = 204). For patients who underwent nerve decompression surgery, postoperative outcomes were collected at the 3 month and 1 year follow-up, including patient reported pain improvement as well as reduction of pain frequency (days/month), duration (hours/day), and intensity (scale 0-10). RESULTS: There were 104 patients (51%) that reported having a past head and/or neck injury, of which 54 (52%) reported their head pain started after injury. The majority of patients (n = 25, 46.3%) reported their pain started on the same day of injury, 10 patients (18.5%) within one week of injury, 4 patients (7.4%) within one month, 3 patients (5.5%) within 6 months, 3 patients (5.5%) within one year, and 9 patients (16.7%) reported “other” pain onset following injury. Mechanism of injury included whiplash (70, 67.3%), direct strike to head (49, 47.1%), direct strike to neck (7, 6.7%), direct strike to head and neck (26, 25%), and other (7, 6.7%). There were 30 (28.8%) patients who underwent nerve decompression surgery. Following nerve decompression, patients with a past medical history of trauma experienced on average a 77.6% improvement in occipital pain with a reduction in number of pain days per month of 23 (p < 0.001), pain duration in hours by 18 (p < 0.001), and pain intensity by 8 (p < 0.001). CONCLUSION: The majority of patients with occipital neuralgia and a history of trauma to the head and/or neck reported their head pain started on the same day or within one week of injury. The most common mechanism of injury was whiplash followed by direct strike to the head. Surgical decompression is an appropriate treatment for pain relief in patients with ON who have a history of head and/or neck trauma.