1332 - Central Sensitization in Suboccipital Neuralgia: A Case of Post-Traumatic Pain Relief via Greater Occipital Nerve Block

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

NT

Nicholas Tranchitella, MD

Resident Physician
UPMC
Pittsburgh, Pennsylvania, United States

Co-Author(s)

PS

Philip M. Stephens, DO

Fellow - Pain Medicine
Vanderbilt University Medical Center
Hendersonville, Tennessee, United States
GG

Gary NF Galang, MD

Director ot TBI services
UPMC Rehabilitation institute
Pittsburgh, Pennsylvania, United States

Submitter(s)

NT

Nicholas Tranchitella, MD

UPMC
Pittsburgh, Pennsylvania, United States

Case Diagnosis: Post-Traumatic Atypical Suboccipital Neuralgia Secondary To Central Sensitization

Case Description: A 23-year-old female presented with GCS 12 after an unhelmeted ATV rollover. CT revealed multicompartmental hemorrhage (thin subdural, scattered subarachnoid) without mass effect, and complex skull base fractures involving the right occipital bone/condyle, jugular foramen, carotid canal, sphenoid sinus, and temporal bone with otic capsule disruption. She was managed non-operatively with C-collar immobilization, seizure prophylaxis, and sinus/skull base precautions. On admission to inpatient rehabilitation, her primary complaint was severe right suboccipital pain radiating down her spine and legs, exacerbated by palpation of the right suboccipital area. Amitriptyline provided limited relief. A right greater occipital nerve (GON) block with 3 cc of 1% lidocaine was performed, resulting in immediate and sustained relief of her symptoms. Her therapy participation and function improved significantly, with CareSet scores rising from 58 to 130 by discharge. She continued to report relief at neurosurgical follow-up.

Discussions: This patient represents an atypical pain presentation of post-traumatic suboccipital neuralgia. A plausible explanation lies in the trigeminocervical complex (TCC), a shared brainstem network integrating sensory input from the trigeminal system and upper cervical nerves (C1–C3). Irritation of the GON, commonly implicated in suboccipital neuralgia, can sensitize second-order neurons in the TCC. This central sensitization not only amplifies local pain but may also facilitate referred or extraterritorial pain, including to trigeminally innervated regions and, in severe cases, beyond the head and neck. In this patient, traumatic skull base fractures with occipital condyle involvement likely triggered aberrant pain signaling within the TCC. The improvement after a targeted GON block highlights the therapeutic value of peripheral nerve interventions in disrupting maladaptive central pain processing and restoring function.

Conclusions: GON blockade represents an effective strategy to alleviate post-traumatic suboccipital neuralgia radiating to the spine and/or limbs by modulating central sensitization within the trigeminocervical complex.