Arnold's neuralgia: description, causes, symptoms and treatment

Arnold’s neuralgia, or large occipital nerve neuralgia, is a problem that causes headaches in the occipital (back) area of the head. As the name suggests, this headache is caused by irritation of the greater occipital nerve, more commonly known as Arnold’s nerve.

In this article, we’d like to tell you more about Arnold’s neuralgia. We provide a definition, a description of Arnold’s neuralgia and the treatment options offered by our team at the Global Medical Institute.

We explain the causes and symptoms of Arnold’s neuralgia, which can be treated by our Global Medical Institute clinic.

Above all, we'll help you understand our treatments and the importance of locating the source of your pain. In some cases, an initial discussion can be held via teleconsultation.

If you can locate the starting point of your pain, our practitioners will be able to help you treat your migraine, whether temporal, occipital or frontal.

At our Global Medical Institute center, we focus first and foremost on the starting point of the pain, before proposing any medical or surgical treatment.

By focusing on the location of the pain, we increase our chances of treating your symptoms.

What is Arnold's neuralgia?

Arnold’s nerve originates between the first and second vertebrae of the neck.

On its way to the skull, it crosses three muscles responsible for the various movements of the head: the inferior oblique (or greater oblique), superior oblique (or lesser oblique) and rectus abdominis muscles. Arnold’s nerve can easily become "trapped" and irritated as it passes through these muscles. Next, these nerves cross the insertion of the trapezius or sternocleidomastoid muscles - muscles linked to the neck, shoulders and head. As a result, every movement of the head can cause one or more pains due to positions that trap the nerve.

Arnold’s nerve ends its course in the scalp. We have two, one on each side of the head.

The Arnold’s nerve is one of the largest sensory nerves, responsible for sensitivity in the occipital area (behind the head to the top of the skull).

What causes Arnold neuralgia?

Arnold's neuralgia can be caused by a local muscle contracture (e.g., following a wrong movement, or due to an unbalanced posture), osteoarthritis, trauma or even stress. There is not always an obvious cause.

As previously mentioned, the nerve passes through several muscles, so it can become irritated if one of these muscles is contracted. At first, the irritation may be episodic, then if the contraction is too sustained, the muscle may cause permanent Arnold's neuralgia.

Arnold’s nerve, as previously mentioned, also passes through the upper cervical vertebrae and subjacent muscles. So you may be predisposed to Arnold’s neuralgia, since the nerve will suffer from this inflammation.

Since movement between vertebrae affected by osteoarthritis is greatly reduced, if you suffer from osteoarthritis in this area, the muscles have to work in unbalanced conditions, which can lead to compression of the Arnold nerve and consequent neuralgia.

Local trauma can also cause irritation or even injury to the Arnold’s nerve. Car accident, whiplash, blow to the head, fall on the head, etc. Injuries are many and varied. The traumas causing Arnold's neuralgia must not be very close in time to the age of onset: several years may pass between the accident and the onset of the syndrome.

Finally, stress and unbalanced posture can lead to muscle tension in the neck, contributing to irritation of the Arnold nerve.

What are the symptoms of Arnold's neuralgia?

Symptoms include: unilateral or bilateral painoriginating in the hollow of the nape of the neck (small hollow between the muscles of the nape) and radiating to the back of the head, the top of the skull and the temples. Pain can also affect the forehead, part of the ear and cause pressure behind the eye; headaches and sometimes hypersensitivity of the scalp.

Among these symptoms, the most frequent is pain felt from the nape of the neck, which then radiates upwards into the head.

This pain is most often likened to a form of continuous burning or sporadic electrical discharges in the area innervated by Arnold’s nerve (the nape of the neck). As a reminder, the pain is classically unilateral, i.e. on the side where the nerve is affected, but may well be bilateral (if both sides are affected).

Headaches may also occur as a result of Arnold's nerve irritation, initially in isolation, but later becoming a daily occurrence.

Hypersensitivity of the scalp is also characteristic of this type of problem.

What treatments does Global Medical Institute offer for Arnold’s neuralgia?

On a day-to-day basis, Arnold’s neuralgia can be very disabling.

To treat the symptoms of Arnold neuralgia, our group focuses on the expression of pain. We base our treatment on the location of the pain’s starting point, and the extent to which it radiates.

To treat the symptoms of Arnold’s neuralgia, occipital infiltrations with cortisone can be a solution. These test infiltrations last around 1 to 2 weeks. Please note, however, that it's not the duration that's important, but the quality. If you feel a significant change in your symptoms, or suffer less from them, then the test is positive.

Our Global Medical Institute group also offers botulinum toxin infiltration. This treatment is generally less effective than cortisone infiltration, but can last up to 2 months.

Infiltrations are not really a treatment, but a test. If your test is positive, your pain becomes much less severe for a few days or weeks, and you are then eligible for minimally invasive surgery to relieve the pain associated with Arnold's neuralgia. We will then decide to use the occipital decompression technique.

In our clinic, we systematically question each and every one of our patients.

We rule out any other disease. The theory behind the surgery is that some migraines are caused when sensitive nerve branches are squeezed and become irritated by the compression of muscles, blood vessels or tendons in the back of the neck. Cortisone infiltrations in the back of the neck can temporarily reduce inflammation of the occipital (or Arnold) nerves for a few weeks. With Botox or botulinum toxin injections, these same muscles, when paralyzed, relieve headaches in some patients for around 2 - 3 months.

Together, our treatments target the symptoms of Arnold's neuralgia by relieving pressure around the occipital nerves.

Minimally invasive surgery is performed through a 4 cm incision in the back of the neck. The scar remains inconspicuous and hidden by the hair. There are generally no sutures to remove. Minimally invasive surgery is performed with the aid of a microscope, and nerves are carefully freed from structures in mechanical conflict. The minimally invasive surgical procedure takes around 45 minutes and can be performed under local or general anaesthetic. Normal activities can be resumed after one week, and physical activities after 2-3 weeks.

In some cases, an initial discussion can be carried out via teleconsultation.