Occipital Neuralgia

Discipline Area: ClinicalCase: Occipital NeuralgiaRespiratory: The lungs are clear to auscultation in the upper and lower fields bilaterally. Breathing isunlabored and there are no retractions or accessory muscle use.Diaphragm: Good movement bilaterallyGI: BS x 4, soft, nontender to palpationGU: DeferredMusculoskeletal: See Osteopathic exam below. Muscle strength is 5/5 and symmetric in the upper andlower extremities. Extremities are without focal sensory or motor deficits.Neurologic: Cranial Nerves II – XII are grossly intact without lateralizing signs. Deep tendon reflexes areslightly increased but are symmetrical in the upper and lower extremities.Lymphatic: No peripheral edema notedSection II: Focus of the Case (approximate time 20–30 minutes)Discussion Questions1. Propose an appropriate differentialdiagnosis / assessment2. What is your final diagnosis?Teaching PointsDifferential Diagnoses:1. C2–C3 subluxation/arthropathy2. C2–C3 radiculopathy3. Migraine headache4. Cluster headache5. Tension-type headache6. Tumor (e.g., posterior fossa)7. Cervicogenic Headache8. Congenital or acquired abnormalities at the craniocervical junction(e.g., Arnold-Chiari malformation or basilar invagination)9. Rheumatoid arthritis10. Atlantoaxial subluxation11. Cervical myelopathy12. Pott's disease/osteomyelitis13. Paget's diseasePrimary Diagnosis: Occipital neuralgiaSecondary Diagnosis: Tension headacheneck painMSDM Type IISomatic dysfunction related to diagnosis: Head, Cervical,Thoracic, and RibsCORE OMM CurriculumResidents 2009-20103