Pain
Nancy Ibrahim, BA
Medical Student
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, United States
Justin Kim, BA
Medical Student
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, United States
Gabriel Howard, DO
Resident Physician
Temple University Hospital
Pipersville, Pennsylvania, United States
Nancy Ibrahim, BA
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, United States
Trigeminal Neuralgia and Occipital Neuralgia Trigeminal and occipital neuralgia are separate clinical diagnoses and rarely occur simultaneously, but share similarities through poorly understood sensitization pathways. Physiatrists should take a detailed history and treat knowing that it is rare to have these be entirely separate etiologies, thus multimodal treatment may be beneficial. This can include gabapentin, physical therapy, botox or nerve blocks, and occipital nerve decompression surgery.3
Case Description: The patient is a 57-year old female with intermittent 10 year duration of trigeminal neuralgia described as episodes of severe stabbing pain in the right V1 and V2 distributions, and diminished hemi sensation of the right face. She has been taking gabapentin since her diagnosis with incremental dosage increases. She presented with new onset pain and “intense burning” in a specific region of her inferior posterior head for a duration of 2 months. The patient was diagnosed with occipital neuralgia, and received a cortisone injection, which significantly reduced her occipital pain. The patient notably has a history including chronic migraines, C4-7 disc herniations, and myasthenia gravis.
Discussions: Trigeminal neuralgia is a disorder characterized by brief episodes of shock-like pain within at least one of the trigeminal distributions usually presenting unilaterally. The three subtypes include classical caused by neurovascular compression, idiopathic, and secondary which is a result of an underlying condition like MS. Occipital neuralgia is inflammation of the occipital nerves, with over 90% of cases due to greater occipital nerve compression.1 Nociceptive afferent input from the trigeminal and occipital nerves converge in the trigeminocervical complex located in the medulla.2 Given the patient had pain in the trigeminal region preceding that of the occipital region by several years, it is important to consider if chronic central sensitization of this complex lowered the cervical afferent activation threshold.
Conclusions:
