Arnold’s Neuralgia: Symptoms, Causes, Diagnosis, Treatment and Prevention

It is a form of headache that causes pain along the upper neck and the back of the head.

The pain is in the distribution of nerves known as occipital nerves (sensory nerves that run from the upper neck to the back of the head).

The pain may be stabbing and burning, or it may feel sharp and stabbing.

This condition is sometimes called occipital neuritis, which suggests that some associated inflammatory changes have affected the occipital nerves.

What are the symptoms and signs of Arnold’s neuralgia?

Symptoms of Arnold’s neuralgia can vary from person to person; most patients will experience pain along the neck where it meets the skull and pain in the back of the head.

The pain can be unilateral or bilateral (located on both sides of the head). It can be sharp or stabbing or feel like an electric shock running along the nerve.

Sometimes that pain is a dull or throbbing ache. The pain can often travel along the side of the head, sometimes as far forward as the forehead.


There may be some symptoms seen frequently with migraine or other headaches, including sensitivity to light or sound or sensitivity to the scalp.

Patients with this type of headache may have more pain when moving their necks.

If the pain caused by neuralgia travels along the side of the head to the face, it could initially be mistaken for a condition known as trigeminal neuralgia.

However, the physical examination and evaluation of the pain history should reveal essential differences that will help lead to the correct diagnosis.

Neck Pain

Neck pain can be more than just an annoyance. Neck pain can come from disorders and diseases of any structure in the neck.

Seven vertebrae are the bony building blocks of the spinal column in the neck (the cervical vertebrae) that surround the spinal cord.

Between these vertebrae are discs, and the nerves of the neck pass nearby. Inside the neck, structures include:

  • Neck muscles.
  • Arteries and veins.
  • Lymphatic glands
  • Thyroid gland.
  • Parathyroid glands.
  • Esophagus, larynx, and trachea.

The disease of any of these structures can cause neck pain.

What is the cause?

The cause of Arnold’s neuralgia is poorly understood. It is believed to occur when the occipital nerves become irritated or inflamed.

There can be many different causes of this nerve irritation, including:

  • Whiplash or another neck injury.
  • Injury to the back of the head.
  • Recurrent muscle spasm or muscle stiffness.
  • Arthritis of the cervical spine.
  • Other structural changes in the upper part of the cervical spine.

Rare causes of this type of headache can include diabetes, infection, or inflammation of different blood vessels.

Is there a test to diagnose Arnold’s neuralgia?

There is no test to precisely diagnose or confirm Arnold’s neuralgia.

Diagnosis is made on physical examination findings, such as marked pressure sensitivity along the occipital nerve; palpation of this region will often reproduce or worsen the pain experienced by the patient.

If the patient has sensitivity over the distribution of the greater occipital nerve, it is essential to make this diagnosis.

There may be some associated muscle tension or spasm in the neck region.

Some doctors perform a nerve block using local anesthesia to see if this will eliminate or relieve pain, helping to confirm the diagnosis.

Neck X-rays, CT scans, or MRI may be ordered if there is concern that some underlying problem is causing the symptoms.

What medical treatment options reduce pain?

Medical treatment for Arnold’s neuralgia can vary.

Conservative treatments such as heat, massage, rest, physical therapy, muscle relaxants, and anti-inflammatory medications are often first-line options.

If pain persists, daily medications can be used to help calm the nerve.

These medications may include anti-seizure or antidepressant drugs. Occipital nerve blocks can be performed with a local anesthetic injection and a steroid agent.

These are often quite successful in relieving chronic pain for several weeks or months.

When combined with physical therapy, daily stretching and strengthening exercises, or other conservative measures, patients with this type of headache can often get better for months.

Some patients find that a past physical therapy course or a single nerve block completely relieves their pain.

If the pain does not respond to conservative treatment options, several more invasive therapies are successful. These include:

  • Rhizotomy (destroy the nerve root to eliminate pain).
  • Neurolysis (applying heat, freezing the nerve, or applying different chemicals to the nerve to block transmission through the nerve).
  • Implant an occipital nerve stimulator (similar to a TENS unit).

Decompression surgery may also be done to open the area around the nerve.

Although there is no specific cure for Arnold’s neuralgia, many effective symptomatic treatment options are available.

Can Arnold’s neuralgia be cured?

For most patients, conservative therapy or occipital nerve blocks are pretty effective in relieving their pain.

For others, the more invasive therapies can be quite successful. As with many other conditions, response to treatments can vary widely.

This type of headache does not lead to other neurological conditions or nerve problems, even if it is not treated.

Can it be prevented?

In many cases, the cause of Arnold’s neuralgia is not found, making it difficult to determine how to prevent this condition.

However, recognizing the factors that cause or contribute to neck muscle tension and avoiding the circumstances that can lead to a neck injury is an excellent place to start.