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What causes severe headache while treating occipital neuralgia?

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Posted on Wed, 11 May 2016
Question: I have extreme head pain from occipital neuralgia. It has been terrible for three days. I wear fentanyl patch, take morphine sulfate 15 mg(11/2 per day and Percocet 5 for break thru pain also have stimulator. Nothing is helping. What can I do to help?
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Answered by Dr. Olsi Taka (3 hours later)
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

I wish you had provided some more info on the different medication you have tried, so that I do not risk repeating something which has not been successful. I will go on mentioning all the options.
I suppose you have tried over the counter anti-inflammatory medication. After that treatment for neuropathic pain is through anticonvulsants (pregabalin, gabapentin, carbamazepin) or antidepressants (amitriptyline, duloxetine).
The next step may be capsaicin or lidocaine cream or patches in the area. Usually opioids which you seem to be taking are the last resort in terms of medication.
In same cases a muscle relaxer such as Baclofen has also had some success.

In terms of other measures you may try there are of course massages, warm compresses and physical therapy, but I guess you are past that.

After those what is left are the more invasive measures which I do not know whether they are an option right now as you say not to be able to have nerve blocks right now. Apart from nerve blocks botox injections are also an option. Other options are radiofrequency, decompression surgery, cryotherapy. I suppose these are not here and now procedures if that was what you were looking for though, they must be scheduled.

These are for the moment the weapons we have against occipital neuralgia. I hope to have provided some option which you haven't already tried. I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3668 Questions

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What causes severe headache while treating occipital neuralgia?

Brief Answer: Read below. Detailed Answer: I read your question carefully and I understand your concern. I wish you had provided some more info on the different medication you have tried, so that I do not risk repeating something which has not been successful. I will go on mentioning all the options. I suppose you have tried over the counter anti-inflammatory medication. After that treatment for neuropathic pain is through anticonvulsants (pregabalin, gabapentin, carbamazepin) or antidepressants (amitriptyline, duloxetine). The next step may be capsaicin or lidocaine cream or patches in the area. Usually opioids which you seem to be taking are the last resort in terms of medication. In same cases a muscle relaxer such as Baclofen has also had some success. In terms of other measures you may try there are of course massages, warm compresses and physical therapy, but I guess you are past that. After those what is left are the more invasive measures which I do not know whether they are an option right now as you say not to be able to have nerve blocks right now. Apart from nerve blocks botox injections are also an option. Other options are radiofrequency, decompression surgery, cryotherapy. I suppose these are not here and now procedures if that was what you were looking for though, they must be scheduled. These are for the moment the weapons we have against occipital neuralgia. I hope to have provided some option which you haven't already tried. I remain at your disposal for other questions.