Differentiating occipital neuralgia from migraine and tension-type headache

Abstract

Objective. To establish differential diagnosis in patients presenting occipital neuralgia, tension-type headache, and migraine with aura. Method. We analyzed 32 patients with Occipital neuralgia (mean age=38.0; females=75%), 102 with tension-type headache (mean age=33.0; females=92.2%), and 16 with migraine without aura (mean age=37.0; females=56.3%). The specific symptoms of headaches were used in according to International Classification of Headache Dis­orders (ICHD) in patients with for craniomandibular disorders and bruxing behavior. Results. Occipital neuralgia group presented more nausea (78.1%; p=0.0001), vomiting (62.5%; p=0.0001), photopho­bia (71.8%; p=0.0001), throbbing (53.1%; p=0.0001), stabbing pain (78.1%; p=0.0001), severe pain (93.7%; p=0.0001), burning (68.8%; p=0.0001), and occipital nerve tenderness (100%; p=0.0001) than tension-type headache group. Occipital neuralgia group showed more stabbing (78.1%; p=0.0001), burning (68.8%; p=0.0005), and oc­cipital nerve tenderness (100%; p=0.0001) than migraine without aura group. Migraine without aura group showed more vomiting (94%; p=0.03) and photophobia (100%; p=0.02) than occipital neu­ralgia group. Conclusions. Nausea, vomiting, photophobia, throb­bing, stabbing, severer pain, a burning description and occipital nerve tenderness, better differentiated occipital neuralgia from tension-type headache. Stabbing pain, burning and occipital nerve tenderness, bet­ter differentiated occipital neuralgia from migraine without aura.