The treatment of occipital neuralgia: Review of 111 cases.

OBJECTIVE: To present the current treatment options for occipital neuralgia based on a retrospective series of 111 patients, who were offered one or more treatment methods, not mutually exclusive.

METHODS: All patients, who previously had their diagnosis confirmed by undergoing an anesthetic nerve block (0.25mL bupivacaine/2mL cortivazol), were treated by radiofrequency denaturation in 78 cases, injection of botulinum toxin in 37 cases and implantation of a nerve stimulation system in 5 cases.

RESULTS: Two serious complications (1 death, 1 permanent hemiplegia) were observed after radiofrequency denaturation, the other methods did not result in any significant complications. Radiofrequency denaturation resulted in 89.4% of good and very good results beyond 6 months, as compared to 80% for the botulinum toxin and 80% after nerve stimulation, no other significant difference occurred between the three techniques, with reservations about the reliability of interpretation for the small sample size in the case of nerve stimulation.

CONCLUSIONS: If radiofrequency denaturation seems to remain the leading treatment for occipital neuralgia, in terms of innocuousness and production costs, botulinum toxin could, in principle, represent the preferred initial treatment for this type of pathology.