American Headache Society 67th Annual Scientific Meeting June 19–22, 2025 Minneapolis, Minnesota

One Sentence Summary: This case highlights the progression of cervical spine degeneration in a patient with Parkinson's disease and cervical dystonia, culminating in occipital neuralgia that responded dramatically to a targeted nerve block and myofascial intervention.Background: Occipital neuralgia is a secondary headache disorder often associated with direct trauma, nerve entrapment, or degenerative cervical spine pathology.In patients with cervical dystonia, sustained muscular contractions may contribute to spinal degeneration and sensitization of nerve structures, including the greater occipital nerve.While the pathophysiology of occipital neuralgia is well-characterized in trauma and post-surgical settings, the structural evolution of this pain syndrome in neurodegenerative disorders like Parkinson's disease is less commonly reported.Methods: Case Description: A 68-year-old woman with a 20-year history of Parkinson's disease and cervical dystonia presented with a two-year history of intermittent, electric shock-like pain in the left occipital and retro-orbital regions.The pain occurred three times weekly, rated 8/10 at baseline, and was triggered by stress.Examination revealed marked left trapezius spasm and tenderness over the left greater occipital nerve.Cervical MRI from 2021 revealed multisegmental disc degeneration, facet joint arthropathy at C2-C3, disc protrusions at C3-C4 and C6-C7, and early foraminal narrowing.By 2024, MRI demonstrated advanced disc desiccation, vertebral body remodeling, facet hypertrophy, ligamentum flavum thickening, and asymmetric left foraminal stenosis at C5-C6.These changes were interpreted as accelerated degeneration secondary to chronic dystonic stress on the cervical spine.The patient underwent a diagnostic and therapeutic left greater occipital nerve block, combined with local steroid injection in the left trapezius.Pregabalin 75 mg was initiated at bedtime.Topical NSAIDs were prescribed as needed.Results: At one-month follow-up, the patient reported 80% improvement in pain severity, with residual symptoms reduced to 3/10 and flares reaching 6/10.She had discontinued systemic analgesics, ABSTRACT reported improved sleep, and had no adverse effects.The resolution of pain following the block supported a mechanically mediated neuralgia.Conclusion: This case illustrates how chronic cervical dystonia can accelerate spinal degeneration, ultimately leading to secondary occipital neuralgia through a multifactorial process involving muscular hypertonia, facet joint arthropathy, segmental instability, and foraminal narrowing.The structural changes observed in sequential MRIs over three years correlated topographically with the course of the greater occipital nerve (C2 dorsal ramus).While entrapment neuropathy cannot be entirely excluded, the patient's rapid and sustained response to nerve block strongly supports a mechanical pain mechanism secondary to postural and degenerative changes.Timely recognition of these patterns in patients with dystonia is critical, and interventional strategies like occipital nerve blocks offer diagnostic clarity and therapeutic value.Clinicians managing Parkinsonian pain syndromes should maintain a high index of suspicion for secondary headache disorders arising from musculoskeletal sources.