February 09, 2026 | Occipital Neuralgia
2 minute read
People often confuse migraine symptoms with something called neuralgia. The former refers to an often disabling neurological condition characterized by severe and sometimes frequent headaches. The latter literally means “nerve pain” with the implication that the condition in question is secondary to some type of nerve injury or dysfunction.
While migraines can be sub-classified in any number of ways, at their core, migraines are caused by chemical dysregulation. This dysregulation can cause blood vessels to become dilated instead of constricted or vice-versa, neurons to fire abnormally (e.g., like epilepsy, but with an aura instead of a seizure) or certain other chemicals to be present at abnormal levels (e.g., serotonin or calcitonin gene-related peptide). In contrast, peripheral nerve surgeons think of neuralgia as a mechanical problem – in other words an object physically and directly pressing on or irritating a nerve. Examples of such objects include spastic muscle, scar tissue from an injury (e.g., ‘whiplash’ suffered during a car accident) or prior surgery, or abnormal blood vessels pressing on the nerves as they pulsate.
Unfortunately, I routinely see patients in my office who have carried a diagnosis of migraines for many years when what they really have is neuralgia. In fact, the average time from the onset of neuralgia symptoms until referral to a peripheral nerve surgeon is 19 years! Moreover, while there are over 39 million migraine sufferers in the US alone, there are approximately 6.5 million chronic migraine sufferers. That means they have headaches at least 15 days out of every month. By definition, standard treatment has failed these patients. So, when someone presents to the office and has a history of chronic headaches, how do you tell whether they are suffering from neuralgia or migraines or some other form of headache? The keys are to perform a thorough history, a specific physical exam trying to discern the answer to the question above, and finally sequential, diagnostic nerve blocks if neuralgia is suspected. If you have had “migraines” for many years and no success with conventional treatment, consider the possibility that neuralgia might be the culprit and seek an opinion from a qualified peripheral nerve surgeon.
