Occipital Neuralgia

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Discipline Area: ClinicalCase: Occipital Neuralgia3. How do you explain the currentstructural findings in the context ofthis case?Are any relevant structuralfindings missing?What would you do differently?Why?Somato-somatic reflexes, manifesting as myofascial changes andsomatic dysfunctions.Missing findings include muscle tightness in the trapezius anddeep musculature of the cervical/suboccipital region, andevaluation of the CRI, TMJ, and neck fascia.These areas need to be addressed4. What pathophysiology & functionalanatomy knowledge is pertinent fordiagnosing/treating this patientPathophysiology and Functional Anatomy The greater occipital nerve is the largest purely afferent nerve inthe body, innervating the posterior skull from the suboccipital areato the vertex. It is formed from the posterior division of the second cervical nerve. Within the substantia gelatinosa of the spinal cord, the afferentfibers from this nerve lie in close approximation to the nucleus andspinal tract of the trigeminal nerve. Rather than exiting through a discrete spinal foramen, the nerveleaves the bony spinal column between the arch of the atlas andaxis. It travels inferolaterally toward the area of the C2–C3zygapophyseal (facet) joint and then curves around the inferioroblique capitis muscle to ascend toward the occiput deep to thesemispinalis capitis muscle. It pierces either through the tendinous insertion of the trapeziusmuscle or between the trapezius and semispinalis muscles toreach the subcutaneous tissue of the occipital area. The site of perforation through these muscles is located just medialto the occipital artery.____________________________________________________________ The lesser occipital nerve forms from the anterior divisions of thesecond and third cervical nerves.It ascends along the posterior margin of the sternocleidomastoidmuscle, where it provides sensory fibers to the area of the scalplateral to the greater occipital nerve.5. What will be your highest yieldregions?6. How does previous trauma influencethese regions?Head, cervical, thoracic. and ribcage regionsThere is no recorded trauma history. However, trauma has to beconsidered as an inciting event.CORE OMM CurriculumResidents 2009-20104
Discipline Area: ClinicalCase: Occipital Neuralgia7. Which 1 or 2 of the aspects below hasthe greatest influence on the patientcomplaint? Pain Fluid congestion Hyper-sympathetic influence Parasympathetic influencePainFluid congestionAll of these aspects have significant influence on the primary complaint.All of them are also modified by the patient’s comorbidities.8. What are the acute or chronic aspects? Acute:headacheChronic:suffering from MS, DM, migraines, and any possible trauma history9. Devise an appropriate treatment planbased on musculoskeletal componentsinvolved in the patient complaintGoals for OMM Management: Physical and manual modes of therapy are important therapeuticmodalities for the acute rehabilitation of cervicogenic headache. A controlled trial testing the effectiveness of therapeutic exerciseand manipulative treatment for cases of cervicogenic headachefound that efficacy was not substantially affected by age, gender,or headache chronicity in patients with moderate to severe painintensity. This finding suggests that all patients with cervicogenicheadache could benefit from manual modes of therapy andphysical conditioning.The treatment plan could include:Osteopathic manipulative techniques such as craniosacral, straincounterstrain, and muscle energy techniques are particularly wellsuited for the management of cervicogenic headache.High velocity, low amplitude manipulation can be carefully used insome patients, though it is not unusual to observe an increase inheadache intensity after manual modes of therapy of this type,especially if it is delivered too vigorously.Physical treatment modalities are generally better tolerated wheninitiated with gentle muscle stretching and manual cervicaltraction.Therapy can be slowly advanced as tolerated to includestrengthening and aerobic conditioning. Using anestheticblockade and neurolytic procedures for temporary pain relief canenhance the efficacy and advancement of physical modes oftherapy.10. How soon would you see the patientfor OMM follow-up?A review of the medical literature suggested that the efficacy ofphysical treatment modalities for the long-term prevention andcontrol of headaches appears greatest in patients who areinvolved in ongoing exercise and physical conditioning programs.Dosing should be dependent upon patient response.CORE OMM CurriculumResidents 2009-20105
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Occipital Neuralgia

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