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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for occipital neuralgia

My daughter in law had 2 shots for the Occipital Nueralgia this morning. The nerve block did not work. The pain continues. She is scheduled for an MRI tomorrow. Are there other shot combinations available and how soon could she get them. She has three young children and a limited support system. She is in Cincinnati and we are ready to head north from Florida--if needed. Thanks. Dave E.
Tue, 30 Jul 2019
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General Surgeon 's  Response
Hi,

Regarding the treatment of occipital neuralgia, there are several options. Usually pharmacological treatment is tried first and if that fails or the drug is not well tolerated local nerve block (injection) is tried and lastly, if nothing works surgery.
Lyrica is one of the first-line drugs so I think it was correct to try it first. Since you say it isn't working perhaps it is time for the injection.
However 100 mg a day you have been taking is a low dose, so to be convinced it's not working you could try augmenting the dose first, at least 150 mg a day (50mg three times a day), can go to 300 mg a day maximum (that is if you don't have kidney impairment or some other contraindication or adverse effect).

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ivan R. Rommstein, General Surgeon
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