Occipital Neuralgia 101

Do you recognize theses symptoms?

People describe ON (Occiptal Neuralgia) as:

• "I have a migraine on a right side of my head"
• "Pain along the neck where it meets the scull"
• "My scalp is tingling, like the skin is crawling"
• "My head is pounding, my neck is tight, my skull is extremely tender"
• "I have this shooting pains at the top of my head"
• "Numbness, throbbing, pressure, dull ache, tingling"
• "Electric discharges along the sides of my head"
• "Sometimes like my scalp is on fire"
• "It's like somebody's squeezing my brain stem"
• "Stabbed with a needle over and over"
• "Sometimes like a cat is clawing my scalp"
• "I feel like I was impaled by a blunt object. goes in the back and come out of my eye"
• "Electric needles are zapping me from inside my head"

There are sudden and explosive outbursts of severe pain in the back of the head that may me similar to migraines (may be due to "convergence" of pain input triggering a common pathway of migraine). Severity of pain may rise blood pressure to extreme levels.

In some cases, the pain is bearable, or mild. However, these sensations may be almost always present. One day, it's numb. Another day, it feels like crawling and waves. Yet another day, you might simply not be able to concentrate or your might be socially anxious.

Some people report eye pain and even dental pain. Some of us have dizziness (presumably due to cervical vertigo).

Note, these symptoms are just anecdotal explanation. It's what people tell they feel. You'll find correct medical terms below.

It's listed here for all of us who feel "it" but cannot describe this weird sensations. It's to let you know that there are many who cannot make sense with all the information available out there.

I'm here to let you know that we might be in the same boat that doesn't have a particular name yet and to welcome aboard another lost "passenger".

About Occipital Neuralgia

Note: this section is to give you a general idea and anecdotal understanding of ON; don't draw conclusions from this section because these are not facts; there's a Medical Explanation section below.

Occipital neuralgia is a specific type of headache that is located on one side of the upper neck, back of the head, and behind the ears, and sometimes extending to the scalp, forehead, and behind the eyes.

The pain, which may be piercing, throbbing, or electric-shock-like, follows the course of the greater and lesser occipital nerves. The attacks are unilateral, with sudden and severe pain prescribed as sharp, twisting or lancing.

Occipital neuralgia is believed to occur due to pressure or irritation to the occipital nerves, which may result from injury, entrapment by tight muscles, or inflammation.

There are two greater and two lesser occipital nerves, one of each nerve on each side of the head. They emerge in the upper neck, from between bones of the spine, and supply sensation to the skin along the back of the scalp to the top of the head, reaching close to the forehead.

Acute continuous occipital neuralgia attacks can last for many hours, with duration of up to 2 weeks before remission. This type is not usually associated with radiating facial symptoms.

In chronic continuous occipital neuralgia, the attacks are accompanied by localized muscle spasms. The pain is described as steady, sharp or aching, with referred pain into facial areas, especially above and behind the orbit.

Unilateral pain is more common, but it can also be bilateral. Scalp tenderness is common. Pain may be increased or be provoked with postures that occur in reading or sleeping positions or with hyperextension or rotation of the head to the involved side.

• Physical findings include pain with palpation of the occipital nerves. Occasionally, there is hyperesthesia or allodynia in the distribution of the occipital nerve.
• Local muscle spasm is frequently found with palpable trigger points and taut bands. Cervical range of motion may be restricted, and neurological exams are typically normal.
• An anesthetic block given at the site of maximal tenderness or at the site of the occipital groove confirms the diagnosis of occipital neuralgia if there is pain relief.
• Treatment may include massage, rest, muscle relaxants, nerve blocks, or injection of steroids directly into the affected area.

About Causes (short)

Occipital Neuralgia commonly caused by:

• injury such as whiplash such as auto-accidents, or other quick head motion (trauma to occipital nerve)
• degenerative changes in the neck region of the spine (spondylosis of the upper cervical spine)
• rarely, nerve damage due to diabetes or tumor
  

ON may be entrapped beneath the attachments of the trapezius and semispinalis capitis muscles to the occipital bone.

There are no reports in Pubmed that ON might be associated with chiropractic manipulation.

If one accepts that whiplash can cause ON, and chiropractic "snapping" resembles whiplash, the lack of evidence is anomalous, says T.C.Hain, MD.

(my view) After several years of research and experimentation, I've come to the conclusion that one the main causes of ON is inflamed occipital nerves. What is the cause of inflammation? There are many but poor diet and mental distress, are at the center of the conundrum (with lack of movement, poor posture, and irregular sleep, playing important role as well). There's so much interconnected damage that happens because of those two factors that (in my opinion) there's no sense in targeting one neglecting the other.

Confusion in Diagnosing

1. ON can be mistaken for migraine, cluster headache, tension headache, or hemicrania continua. (Link)
2. Occipital neuralgia is a multifactorial problem where multiple anatomic areas/structures may be involved with this pathology. (Link)

Occipital pain is a common complaint amongst patients with headache, and the differential can include many primary headache disorders such as cervicogenic headache or migraine.

What’s important is to understand from the very beginning is that ON may be just one of the issues which had surfaced and became "too-much-to-bear". That is why (very often) treatments do not work long-term, with a temporary relief, but come back with time.

I'm talking that you may be experiencing a multi-level outplay of underlying issues where only one of several surface manifestations is called occipital neuralgia.

Of course, you want to deal with the pain before diving into the roots of the problem. Understandable. Do what you must. We all have different levels of pain and tolerance for it.

We have a self-help section below for that.

Odds are that if you're reading this, you have some time; probably, you can tolerate your pain and you're somewhat desperate to find answers because you've been searching for awhile.

The fact that there might simply be no direct answer is the core realization behind the reason why ON problem isn’t an easy one.

But on a bright side, if you choose to tackle the problem at its root, chances are that you will not only deal with ON but begin to heal that which you didn’t even know was off, regaining forgotten levels of aliveness and balance.

It is a truth which I’m living personally and scientific research shared below supports this perspective. Don't put it all in an "vain-talk" trash bin. Do your own investigation.

One thing I want to add: we need to understand that in this case we must do the work to see true results. There’s no other way. It’s your precious body we are talking about. Don’t be angry at it. We are responsible for it. Not doctors. Not the system. Only us. Now, let’s see what we got.

Facts about occipital neuralgia

• Note that pain in the occipital area (back of the head) is not necessarily an indicator of ON. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution of the greater, lesser or third occipital nerves. (Source)
• Occipital neuralgia is actually very uncommon, especially in comparison to migraine. For example, in Dr. Hain practice, it's one case of ON for hundred cases of migraine.
• One study found that hypoesthesia (reduced sensitivity) was the most common sensory change in participants with dysaesthesia (unpleasant, discomforting sensation) and paresthesia (burning, or prickling sensation) appearing in smaller numbers.
• Interestingly, one study demonstrates that out of 500 patients suffering from migraine 48% were found to have occipital neuralgia. That means that if you often experience migraines chances are you may also have occipital neuralgia.
• Another finding is that 90% of cases involve the greater occipital nerve (GON) and only 10% affect lesser occipital nerve. That’s the reason GON is considered the source of occipital neuralgia and most studies’ center of attention is GON only. P; To remind, greater occipital nerve goes over your head ending behind your eyes while lesser occipital nerve goes above your ears.
• Steven Waldman, MD, JD, in his book Pain Review, says that Occipital Neuralgia may be caused by repetitive microtrauma from working with the neck hyperextended (e.g., painting ceilings), or working for prolonged periods with computer monitors whose focal point is too high, causing extension of the cervical spine.

Medical Explanation

Neuralgia is pain in one or more nerves caused by compression and/or irritation of peripheral nerve structures. Pain in the distribution of a nerve or nerves. Trigeminal neuralgia, one of the most common primary neuralgias, is characterized by a jabbing pain in one or more of the distributions of the trigeminal nerve. Neuralgic pain is fairly characteristic: it is an electrical, shock-like pain.

Definition and Symptoms

Occipital Neuralgia is a paroxysmal (sudden, violent attack) jabbing/shooting/stabbing pain in distribution of the greater, lesser, or third occipital nerves that is commonly associated with tenderness over the nerve concerned (definition by The International Classification of Headache disorders).

In other words, it's a violent pain at the area of the skin where occipital nerves locate. That is, over the top of your head and behind your eyes for greater occipital nerve, and over your ears for lesser occipital nerve.‍

‍In some cases ON shows as hypoesthesia (partial loss of tactile sensation or numbness) as well as dysesthesia which is a burning, itching, wetness sensation. All that in addition to the pain in affected areas.

Some medical authors say that it may or may not include frontal and periorbital spread of pain.

This type of pain is reported by patients as lancinating and knifelike as well as sharp, severe and shooting. It may last between a few seconds to several minutes. Also, there might be pain between the attacks.

Most common occipital region (back of the head) symptoms of ON are:

• hyperalgesia
• hyperaesthesia
• dysesthesia
• paresthesia
• hypoesthesia
  

Other symptoms include:

• nausea
• dizziness
• blurred vision
  

Occipital Neuralgia can awaken you during the sleep, or happen any time during the day.

Causes

Although any of the following may be one of the causes of ON, many cases can be attributed to chronic neck tension or unknown origins.

• Osteoarthritis of the upper cervical spine
• Trauma to the greater and/or lesser occipital nerves
• Compression of the occipital nerves
• Compression of C2 and/or C3 nerve roots from degenerative cervical spine changes
• Cervical disc disease
• Diabetes
• Blood vessel inflammation
• Infection
• Gout
• Tumors affecting the C2 and C3 nerve roots
  

In ON, irritation of the occipital nerves by chronically contracted muscles and spondylosis of the upper cervical spine is often implicated (4,5).

Diagnostic Criteria

According to the International Classification of Headache Disorder (ICHD-II), ON belongs to the same family as cranial neuralgias, central and primary facial pain, and other headaches.

The diagnostic criteria are as below:

A. Paroxysmal stabbing pain, with or without persistent aching between paroxysms, in the distribution of the greater, lesser, and/or third occipital nerve

B. Tenderness over the affected nerve

C. Pain is eased temporarily by local anesthetic block of the nerve.

Like many other common health conditions, psychiatric conditions, or even migraine, Occipital Neuralgia is diagnosed solely from symptoms, relief from nerve block, and signs of severe pain (such as hypertension) during attacks.

Tenderness the size of a quarter can be felt by touch 1/2 to 1 inch below the base of the skull. This focal tenderness represents the site of penetration of the greater occipital nerve through trapezial fascia.

For a person with severe tenderness just under their occiput, the pain may originate from:

• occipital neuralgia
• cervical facet pain (syndrome)
• migraine and variants (tension, cluster)
• myofacial pain syndrome with a trigger point in occipital area
  

The IHS considers the diagnostic criteria for occipital neuralgia as follows:

• Paroxysmal, stabbing pain, with or without persistent aching between paroxysms, in the distribution of the greater, lesser, and/or third occipital nerves.
• Tenderness over the affected nerve.
• Pain eased temporarily by local anesthetic block of the nerve.
  

Not A Primary Headache

Occipital neuralgia is not classified as a primary headache disorder which is a headache as a disorder itself. Also, unlike many secondary headaches, it’s not caused by menstruation, physical fatigue, change in the weather, alcohol, tobacco, food allergies, or emotional factors.

Overall, occipital neuralgia is described as chronic, debilitating, and disabling condition which leads to decreased productivity, dependence on pain medication, and frustration of both patient and doctor.

Which Tests Are Appropriate

It can be difficult to distinguish ON from other types of headaches. A thorough evaluation will include medical history, physical examination and diagnostic tests.

If there are abnormal findings on a neurological exam, the doctor may order the following tests:

• Magnetic resonance imaging (MRI): a test that produces 3D images of body structures; can show direct evidence of spinal cord impingement from bone, disc or hematoma.
• Computed tomography scan (CT or CAT scan): a diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents and the structures around it.
  

"To the best of my understanding, Occipital Neuralgia cannot be recognized solely from tests like blood", says Dr. Timothy C. Hain, one of the most respected and recognizable figures dealing with dizziness and balance issues practicing in US.

(my view) MRI or CT scan of the skull base are common. CT of cervical spine shows cervical facet joints while MRI is used to look at the soft tissue of the neck. Magnetic resonance imaging is the most important tool in the diagnosis of this disorder as it enables visualization of the surrounding cervical and occipital soft tissues. A simple X-ray is useful to rule out underlying pathologies, such as arthritis and craniocervical instability.

Treatment (conventional)

The goal of treatment (medical) is to alleviate the pain. Often, symptoms will improve or disappear with heat, rest and/or physical therapy.

Occipital Neuralgia can be extremely painful. Generally, nerve blocks are used for pain treatment as well as to confirm the diagnosis of ON.

Blocks are injections of medication to temporary deaden pain nerves. If it doesn't work, pain is probably coming from somewhere else.

"Medications usually aren't helpful", says Dr. Hain, "but when ON is combined with migraine, it's useful."

Radiofrequency lesioning of the greater occipital nerve can relieve symptoms but there is a tendency for the pain to recur during followup.

What is a Nerve Block?

Occipital nerve block is a therapeutic procedure to alleviate pain originating in the occipital/suboccipital region (back of the head).

It's executed by injections of steroids (as well as local anesthetic) into the base of the skull targeting the location of occipital nerves.

In an occipital nerve block, pain-relieving medication numbs the nerves which inhibit the flow of information (pain).

It's said that occipital nerve blocks can also be used to "reduce swelling and inflammation in the back of the head".

"Local injections (corticosteriods) may improve symptoms but temporary", says Dr. Hain.

It is important to keep in mind that the use of steroids in nerve block treatment may cause serious adverse effects.

Oral Medications for Nerve Pain

Aspirin or acetaminophen, nonsteroidal analgesics such as torodol, and narcotics are frequently used for neuralgia. Usually, non-narcotic pain killer are not strong enough to control neuralgia pain. Narcotic meds are highly addictive.

As an alternative, try Neuralease.

Durable Treatments

I wouldn't even begin to discuss all that, personally. But in order to show you the full picture, as promised, here you are. Source

• Radiofrequency ganglio-neurectomy (RFGN) involves damaging a nerve by heating it with microwaves. It is less invasive than rhizotomy as one just needs a needle rather than open surgery. This procedure is usually performed by pain clinic physicians. Pulsed radiofrequency treatment is a promising treatment. It has roughly a 50% success rate, with success being correlated with use of several procedures. . A problem with RFGN is denervation pain -- which may be worse than the original neuralgia.
• Micro-vascular decompression surgery of the occipital nerve can be done at several sites. Ducic et al (2014) reported an 86% response rate in a metanalysis of 14 studies of nerve decompression. This is an outstanding result compared to the other approaches reviewed here. Dr. Jho also reports success with decompression.
• Rhizotomy surgery means cutting of nerves. Rhizotomy may be used to convert a neuralgia into a numbness. Of course, rhizotomy may also cause denervation pain.
• Cryo is another way of damaging the nerve. While it may have some advantages over RFGN, including a partial damage rather than complete nerve section, the appropriate probes to treat ON are not available in the USA.
• Occipital nerve stimulation uses a neuro-stimulator to deliver electrical impulses via insulated lead wires tunneled under the skin near the occipital nerves at the base of the head. The electrical impulses can help block pain messages to the brain.
  

"At the present writing (2015), none of these methods seem entirely satisfactory, but decompression surgery and RFGN (done very cautiously) would seem to us most suitable right now", says Timothy Hain. "Treatments appear to be in very slow evolution. We find it puzzling that section of the occipital nerve, through RFGN or just rhizotomy is not done more often."

Physical Therapy

Goal: decrease muscular irritation associated with the underlying cervical strain; to reduce the inflammation of the greater occipital nerve. (Which is of course only the beginning).

Restrict movement of the head, limiting rotation, bending, and flexion. Recommend ice applications to control acute muscular spasms.

Alternative Nerve Pain Relief by Dr. Jacob Teitelbaum

At this point, many doctors don’t know how to treat neuropathy, incorrectly prescribing anti-inflammatories such as Motrin – which internal medicine specialist Dr. Jacob Teitelbaum said needlessly take the lives of more than 16,000 people annually in the US.

Thankfully, though, there are reliable natural treatments for neuropathy.

Five supplements for neuropathy relief

According to Teitelbaum, research has repeatedly demonstrated that supplementing your diet “with lipoic acid 300 mg 2x day, Acetyl-L-Carnitine 2,000 mg a day, Inositol (500-1,000 mg a day), and vitamins B6 (50-100 mg a day) and B12 (500-5,000 mcg a day) can actually help heal the nerves and decrease or eliminate the pain.”

It takes time

Keep in mind that natural solutions need time to do their work, since the end goal is not to mask your pain but to heal the damaged nerves. Hence, substantial neuropathy relief using these nutritional solutions may take as long as 90 days or even a full year.

“It is, of course, critical to begin by … giving the nerves what they need to heal,” argued Dr. Teitelbaum."

You will be amazed at how much benefit you may get over time simply from optimizing nutritional support.

Overlap of symptoms

"Many patients suffer from more than one type of headache. This may result from different etiologic factors or may represent a change in character of a chronic headache disorder." - NCBI, Clincal Methods Book, G. Kim Bigley, Link

The point here is that probably most of us don't have just one distinct underlying pathology but an amalgamation of confused signals and symptoms originated, or intensified, by the issues in the upper cervical spine.

This confusion and perplexity among sufferers as well as doctors is very common. And it's understandable: our lives are excessively filled with experiences and habits which quickly subside under the surface due to lack of awareness. I mean that we can easily - throughout the years - accumulate a number of pathologies which later join together in a sort of eruption.

When some critical mass is reached (when body cannot longer silently adapt), one of the dormant issues might be triggered by psychological overwhelm, by a physical injury, or simply because it's a consequence of a our lifestyle.

As a result we experience confusing collection of signs and symptoms - a mixture of errors from different regions and systems piling on top of each other. For example, you might notice characteristics of occipital neuralgia intersecting with migraines or other types of headaches.

(my view) Note, that any type of neck forward inclination for long periods of time - so it creates tension in the cervical spine - might bring an array of problems to the junction of nerves, blood vessels, joints, and muscles, in your occipital area. Along with generally misaligned spine and "bad" posture, your desk job and your phone, it will easily bring a variety of symptoms to the surface such as occipital neuralgia, cervicogenic headache, migraines, vertigo, or perplexing dizziness.

What is the Origin of Pain in Headaches?

Without getting too much into details, here's a common mechanism of headache pains:

• Headache pain is a result of an inflamed tissue, blood vessels, and/or changes in the release of neurochemicals which send pain signals in CNS.
• Cranial region (upper part of the head) is filled with pain sensitive nervous network, web of muscles and soft tissue.
• Thus, when inflammation or other irregularities occur in these structures - the result is often a throbbing headache.
• It's not your head that hurts - it's this network blood vessels, nerves, and fragile tissues, which are sending signals through CNS back to your brain to recognize it as physical pain.

Cervicogenic headaches

"Cervicogenic headaches resulting from pain from the nerve roots in the upper neck may have similar symptoms as ON, but typically are described as dull ache as opposed to piercing or stabbing pain", says Dr. Ziv Peled.

CGH is a controversial topic. It's not fully accepted as disorder itself and often considered a pain syndrome. Commonly cited sources of CH are cervical nerves and their branches (C2 and C3).

There's no established definition. CGH is defined by its clinical characteristics - one-sided pain of variable severity with dull and not stabbing pain. It's brought on by head position, neck motion, or may be associated with shoulder or upper extremities pain on the same side.

There's diagnostic criteria established for CGH but its characteristics overlap with headache disorders such as migraine, tension-type, or hemicrania continua.

Dr. Timothy C. Hain says, "ON must be distinguished from referred pain from the cervical joints, or from trigger points in neck muscle or their insertions (cervicogenic headache).The critical differential point is that ON is neuralgia originated in the occipital nerve, whereas cervicogenic headache is nociceptive (physical damage) referred pain from cervical structures."

Tension-type Headaches

Tension-type headache, which is much more common than occipital neuralgia, will occasionally mimic the pain of ON.

Occipital Neuralgia, Dr. Waldman says, is not a frequent cause of headaches. Often, pain in the occipital region is in fact a result of tension-type or cervicogenic headaches.

(my view) It's worth to mention that Waldman's book (where I found the above) was published in 2009. Distribution of pathology might have been shifted. However, I feel that an increasing rate of daily use of devices could only increase the number of cases of occipital neuralgia as well as both tension-type and cervicogenic headaches.

Interestingly, tension-type headaches won't respond to occipital nerve blocks, Waldman continues. Therefore, the clinician should reconsider the diagnosis of occipital neuralgia in those patients whose symptoms are consistent with occipital neuralgia, but fail to respond to occipital nerve blocks.

(my view) What does it mean for us? First of all, it means that if you've done nerve blocks and they didn't work, chances are your symptoms don't come from occipital nerves itself. They might be affected by something else but they are not the origin themselves. In that case, you may be suggested antidepressants such as amitriptyline in conjucntion with cervical steroid epudural nerve blocks. Why? Because tension-type headaches are very amendable to this type of treatment.

Migraines

It’s well recognized that occipital neuralgia (ON) often serves as a trigger for migraines (M). The theory behind it is that upper neck is an intersection of occipital and trigeminal nerve, and disturbance of one part of this complex nervous web may cause a response in the whole tree of nerves.

Greater occipital nerve blockade with anesthetics and/or corticosteroids can aid in confirming the diagnosis and providing pain relief. However, nerve blocks are also effective in migraine headache and misdiagnosis can result in a false positive. (Source)

A small study demonstrated that out of 35 patients with ON more than 50% had Migraine (M) symptoms in addition to ON.

There may be significant differences in pain characteristics for patients with ON + M and those for patients with isolated ON.

The data indicate that patients with migraine should also be screened for symptoms of ON, as there may be similarities in presentation.

The clinical implications of distinguishing ON + M and isolated ON include differences in treatment regimen, avoidance of inappropriate use of medical resources, and differences in long-term outcomes.

(my view) I know. Dry and lifeless information. But that is the state of research as of today. Plus, migraines still remain a condition with unknown causes. Personally, I haven't been diagnosed with migraine but based on the diagnosis criteria I've been having episodes for the past 10 years. Of course, I may be mistaken. It's just all mixed up in a noisy soup of vertigo symptoms and other types of headaches that sometimes I cannot really tell the difference.

C2 Neuralgia (type of Occipital Neuralgia)

Even though International Headache Society (IHS) does not differentiate between C2 Neuralgia and Occipital Neuralgia, according to Waldman, C2 is a type of ON.

It's caused by lesions of the C2 nerve root, or dorsal ganglion, such as neuroma, meningioma, or anomalous vessels. Inflammation of the atlanto-axial joint ma lead to irritation or entrapment of the nerve root.

C2 neuralgia manifests as intermittent lancinating occipital pain that is associated with lacrimation (tears), ciliary injection (red eyes), and rhinorrhea (nasal cavity is filled with a significant amount of mucus fluid).

(my view) I, personally, experienced all three of C2 neuralgia symptoms (if I've interpreted them correctlly) as well as a number of other signs "unique" to other pathologies that adds to the overall confusion. I'm positive that seeking and searching for something particular to hit/smash with treatment and aid, is a waste of time, money and potentially damaging to the natural way of things in your body. That's why I believe that healing begins (and sometimes ends) when we change fundamentals.

Self-Help: Relive the Pain and Calm Your mind

If you're in pain, or you're mentally overwhelmed, you cannot think about anything except getting rid of the pain. Anything else seem like a joke and the only thing you want is to get back to "not-feeling" this debilitating sensations.

So, let's deal with pain and overwhelm first even if the pain is mild and mental distress is bearable. It takes toll on your life over time.

So, you might want to soothe yourself in the most efficient way before you can calmly see if you're interested in going deeper.

We need to feel some relief in order to bring "breathing" space - the only place where any true healing can happen.

Consider the following an essential entrance to a more comprehensive self-healing series. You can find them here.

Ginger

Ginger is a healing powerhouse for a human body. It's one of the most studied gifts of nature with a capacity to help you with you nerve pain, headaches, and migraines.

Here's a short overview about Ginger:

• Traditionally used to treat inflammatory and infectious ailments
• Takes effect in 25 minutes and lasts for at least four hours
• Shows to be significantly more effective than placebo
• Improves migraine symptoms better, or on the same level, as precipitation drugs, link
• Lots of clinically proven other health benefits, link
• Studied in comparing ginger with prescription drugs - this, this, and this
• Better than Dramamine at suppressing motion-induced nausea
• Helps with Vertigo in controlled clinical study, link
• Better with BPPV (positional vertigo) than manual repositioning (Epley)
• Demonstrated to be effective anti-inflammatory agent as well as to help with nausea and vomiting
• ginger may help to prevent some of the side effects associated with conventional painkillers as well.
• ginger may help protect the lining of the stomach from damage due to these drugs, as well as alcohol and excess hydrochloric acid produced by the stomach in some conditions.
• May prevent side effects of conventional painkillers and alcohol - helps to protect the lining of the stomach
  

If supplement, typical dose is a 550mg capsule at the first sign of headache. Maybe be repeated.

You can also mix half a teaspoon of powdered ginger in tea, or another warm beverage. I simply drink it with warm water sometimes. But you need to double your ginger if using fresh grated ginger root (which can be steeped in boiling water for 5 minutes). Add honey to alleviate bitterness.

It will certainly help. Give it a try when you experience headaches, migraines, dizziness, or symptoms vertigo.

Turmeric

Turmeric is another root (part of a ginger family) that helps alleviate different types of pain. It's been studied and used extensively in both traditional medicine and western medical practice.

• Active compound in Turmeric called Curcumin
• Curcumin is not completely absorbed by itself (better to use curcumin supplement, or add black pepper which helps with absorption)
• Plenty of evidence of its anti-inflammatory effects, nerve pain reduction, migraine pain reduction, and more
• Extensively studied with more than 37 different health benefits
• Even though the research is limited on Turmeric's direct effects on headaches, plethora of other positive effects may bring about relief by balancing and healing underlying imbalances in the body
  

*For headache: 500mg every 3 hours as needed. Take 4 in a day at most and may be used with most other headache medicines. May be combined with ginger or triptans. Limit to 5 days a week at most.

Or, 1/4 ts turmeric powder with 2 tbs of lemon juice and dilute with 1/2-1 cup of warm water, sweeten with honey.

Caution: Medications that slow blood clotting (Anticoagulant/Antiplatelet drugs) may interact with turmeric.

By National Institute of Health: "Research suggests that curcumin can help in the management of oxidative and inflammatory conditions, metabolic syndrome, arthritis, anxiety, and hyperlipidemia. It may also help in the management of exercise-induced inflammation and muscle soreness, thus enhancing recovery and subsequent performance in active people. In addition, a relatively low dose can provide health benefits for people that do not have diagnosed health conditions."

Together. Ginger and Turmeric. Golden Tea.

This is my go-to remedy for all iterations of my headaches and anxiety. It helps me to sleep better. It helps me to unwind after a long day. It helps me to relax into my chair and just smile.

I don't know more effective and delicious way to soothe the pain in the head as well as calm my mind.

Taking Ginger and Turmeric together is shown as the way to reduce pain even more effectively than taking those separately. And it may surprise you but the "mixture" made correctly is actually pretty comforting, warming, and calming.

Golden Tea (in its simplest form) is an easy-to-make paste of ground turmeric, ground ginger, cracked black pepper (increases absorption of turmeric), and raw honey. You can prepare a paste, put it into container, and have it ready with you in case you'll need a cup of pain-relieving warm brew.

To increase the level of absorption of turmeric (and with that - overall benefits) it's better to add healthy fats like coconut oil and drink using warm water, or milk.

Below you will find a general recipe as well as upgraded version which I personally prefer after several years of experimentation.

Original Golden Milk (experiment with ratios along the way):

• 1 Cup of milk (I recommend coconut, or almond)
• 2 tablespoons of turmeric powder (or more to taste)
• 1 teaspoons of black pepper
• 1-2 cup of honey (adjust for your taste)
• Just mix a teaspoon of this paste in a warm cup of water and drink as a warm beverage
  

Upgraded Golden Milk - everything from above, plus:

• Add 1 tablespoon of coconut oil, or MCT oil (to help with absorption)
• Add 2 tablespoons of ginger (reduce if it's too bitter)
• Add 1 teaspoon of ground cinnamon (just to make it more comforting)
  

Upgrade Golden Milk for nerve pain:

• Add a squeeze of lemon and a dropper-full of feverfew extract
• NOTE about Feverfew extract: It's one of the most studied herbal supplements on the market. It's used to relieve pain and inflammation all over the world. Particularly, it's effective with chronic pain which results from hypersensitivity known as "skin sensitivity". It's worth to mention, migraine sufferers use feverfew extract as a treatment. Feverfew has been used for centuries to treat headaches, stomachaches, and toothaches. Nowadays it's also used for migraines and rheumatoid arthritis. More studies are required to confirm whether feverfew is actually effective, but the herb may be worth trying since it hasn't been associated with serious side effects. Mild side effects include canker sores and irritation of the tongue and lips. Pregnant women should avoid this remedy.
  

Upgrade Golden Milk to calm your mind:

• Add 1 teaspoon of ashwagandha powder
• NOTE about Ashwagandha: It is an adaptogen (class of herbs). Adaptogens are known for combating your body's stress response and calming your mind. There's a section on adaptogens and their amazing qualities, especially in the situation of an stressed and agitated mind that is often the case with headaches and migraines.
  

Gingko Biloba

Gingko is used in many countries to treat everything from cognitive decline to vestibular disorders and altitude sickness. It's well known to have anti-inflammatory and antioxidative effects.

So, in case of headache or migraine - when stress is almost always a companion - gingko may be especially useful.

Also, it's been used in traditional medicine all over the world to improve reduced blood flow to the head which often contributes to a headache.

• One of the oldest living species of trees in the world and one of most widely researched herbs worldwide
• Well known for increasing blood flow to the head and brain
• At least as effective as the world's most popular agent (betahistine) for treating vestibular issues (think vertigo-like symptoms)
• Improves neuronal plasticity (ability of the brain to change its structure), mitochondrial function and energy metabolism (levels of energy in your body and in your life), link
• Shown to improve equilibrium disorders, link
  

If taking supplements, there's no clearly defined dosage. Start slow. Take no more than 150-250 mg a day and see how you feel.

Gastrodin

Tian Ma extract (from an orchid) is famous Chinese herb that has been extensively used for treatment of headache, dizziness, spasms, epilepsy, strokes and other disorders for millennia.

• Demonstrated a broad range of biological activities on central-nervous benefiting neurological diseases and psychiatric disorders, link
• Able to protect nerve cells from inflammatory damage and promote neuroregenerative processes.
• Extensive research has been done and concluded that this treatment was more effective than medication.
• When given with anti-nausea medication (phenergan), can relieve acute emergency vertigo.
  

Cayenne

Cayenne contains capsaicin, which helps improve blood flow towards the inner ear and brain, thereby reducing the symptoms of dizziness and vertigo. In combination with apple cider vinegar (which is shown to reduce blood sugar levels), blood sugar spikes are greatly reduced - a factor that definitely contributes to headaches.

I drink this mix at least once a month for several days in order to balance things out. It feels so afterwards. And I'm not alone. There's a flood of people raving about it. Of course, as with everything, don't abuse it. Most importantly, pay attention to your body and how it responds.

Here's the way I prepare this mix (followed by the experience of thousands of people):

• Teaspoon of cayenne
• Half a teaspoon of black pepper
• Pinch of salt
• Tablespoon of unpasteurised ACV (apple cider vinegar), like Bragg ACV
• Raw honey to your taste (begin with 1.5 - 2 tablespoons)

Vital Combo: Magnesium and Omega-3 Fatty Acids

These two are not necessarily about relief from the pain but about healing the "foundation" of your body to support a pain-free state.

I'm including those because chances are you are deficient in those (majority of population is). If you're taking those as a supplement already, please ignore this section.

For me, when I've began taking magnesium - and soon after that Omega-3 - I've noticed increased energy levels, better sleep, and you cannot help but realize that your aliveness is on a different level. I've heard stories like that from many people. Of course, every one's organism is different.

However, due to the commonalities in food supply, most of us will benefit from taking those two elements as supplement because so much processes in our bodies are connected to both of them.

Vital Combo consists of:

• Magnesium (deficient in majority of us and important player in enormous amount of biological processes in the body), and
• Omega-3 (deficient in many and essential for brain health)
• I don't even put links here because of the ocean of material out there connecting "those two" to, basically, being heathy
  

Magnesium

• Magnesium deficiency is extremely common and is a major contributing factor to neuropathy: magnesium is required for the proper firing of neurotransmitters inside the human body.
• Magnesium is a critical mineral, involved in about 80% of known metabolic functions, yet about 60% of adults don’t achieve the dietary intake
• Central nutritional importance in your body energy production
• 40 years of studies, 2000 new ones every year
• Deficiency may be in part due to 80-90% decline of mineral content in vegetables in the last 100 years
• Shown to help migraine sufferers
• Lots of studies for depression and anxiety, link
• Helps ease muscle tension.
• Calms your body, calms your brain.
  

Omega-3 Fatty Acid

• It helps with neuropathy due to anti-inflammatory effects and its ability to repair damaged nerves.
• It helps to relieve muscle soreness and pain.
• Plays important role in your body and have numerous health benefits with vast scientific body of research
• Your body cannot produce them on its own, you need to get them from your diet, or by supplementing
• Foods that are high in omega-3 fatty acids include fatty fish, fish oils, flax seeds, chia seeds, flaxseed oil, walnuts
• Omega-3 fatty acids (particularly DHA) are vital for your brain and eye retinas
• Studies link higher intake to a reduced risk of inflammatory issues and depression
• Found one study showing that 2 months of supplementation with 1g of omega-3 fatty acids caused 74% reduction in the duration of their migraine headaches (one study, I know, but still)
• Another study demonstrated that Omega-3 fatty acid taken together with turmeric shown great results with migraine patients (just to motivate you a little more)

Self-help: Stop the harm before you can heal

Please understand - to get rid of that which make things worse is equivalent to a treatment; actually, it is the most effective and efficient treatment of all. That's why determining and eliminating that which may trigger your pain, headaches, anxiety, and overall "off-state", will probably yield the best results.

So often we are oblivious to the fact that our habits (sometimes life-long ones) is what we are feeding our diseases with.

Below are the list of 3 essential things that you simply have to eliminate (or, lessen) from your life if you really want to do something about your nerve pain, headaches, and this endless mental assault.

I understand that it's unrealistic to ask you to eliminate everything at once. However, if you want to improve, do the work on yourself.

Elimination of things that harms you is the foundation because it doesn't matter how great is your treatment plan and your doctor - if you are not responsible and diligent with fundamentals then everything else is temporary and ultimately worthless.

Cigarettes and Alcohol.

These two are the main contributors to the symptoms - headaches, mental stress, overall low state. Both cigarettes and alcohol are toxins for nerves. They cause nutritional deficiencies that worsen neuropathy.

Smoking has been linked to vertebrae disc degeneration which is a cause of a multitude of problems stemming from your neck including all sorts of headaches, balance problems, nerve pain, and much more.

Alcohol and cigarettes directly damage inner ear by creating toxic environment that destroys tiny hair cells which "translate" sounds to the brain and help the brain to process your position in space. Basically, your inner ear is a hub for interpretation of the outside world and your place in it. If your inner mechanism for "translation" is disrupted and under assault, your system is simply overloaded, dizzy, and confused.

It's all a very researched subject but it's more a question of quitting rather than understanding the logic of it. I know.

You should understand that smoking and drinking alcohol diminishes the results of any treatment that you may undergo.

Find your inner willpower and cut those immediately from your life. Through pain, irritation, and even more headache symptoms. I'm talking from experience here as someone who struggled to stop even when things were really bad.

But there's nothing, nothing, more liberating to realize how much damage you have been able to prevent by ending your relationships with those addictive substances. There's actually way for you to find peace with your inner voice that won't stop seducing you. It's getting less and less loud so you can see it but not be controlled by it.

So, if you drink alcohol or smoke cigarettes, and you experience symptoms like headache, dizziness, nerve pain, vertigo, migraine - you must find a way to stop because those two directly and negatively effect parts of your body which otherwise could begin healing themselves.

Lower your refined carbs intake (refined sugars and refined grains).

Simply put - refined carbs is one of the main causes of inflammation and odds are that your nerve pain, or headache, is greatly influenced by inflamed nerves. Plus, blood sugar spikes is a major contributor to headaches, nerve pain and other bodily tensions.

Sugar itself is not what causes, or triggers, headache. More precisely, a quick change in blood sugar levels is the reason.

Excessive consumption of refined carbohydrates (which are "sugars" and refined grains without all bran, fiber, and nutrients) may cause spikes in blood sugar levels. That might be the trigger - and in a sense a cause - of a lot of issues including inflammation, stress, and headaches.

You may already know how harmful refined carbs are. Or, you may not. But the problem is that even with so much scientifically proven data regarding damaging effects of refined sugars many of us still cannot deal with the habit of sweets.

For me, refined carbs was a huge trigger of headaches

In my experience, sugar definitely was a huge trigger for both mental and physical distress. Whenever I would manage to create a relatively balanced inner state I would be drawn to all sorts of "distractions" including sweets and pastry.

Almost every time in the past I couldn't stop myself, especially after a period of withdrawal. But even if I'd eat only a small piece I'd notice my inner scales to go out of balance. Headaches and mental fog would follow. Next to that - I find myself indulging in everything else I could find because of noisy thinking and a sense of guilt.

So, if you read this and have a similar problem with headaches - cut your refined carbs for 2 weeks and just see what happens. It's simple and difficult at the same time. Just experiment. And if you're able to go 2 weeks and you feel ok - go longer. That's how it happens. But the truth remains - you need to find a way to cut out refined carbs from your life once and for all.

What exactly are refined carbs?

Table sugar, Sugar-filled drinks, sugar-loaded desserts, sauces with lots of sugar, canned foods with sugar, so-called "healthy" snack foods, sugar-filled breakfast foods and cereals, white bread, white rice, pastries, pasta, sweets, breakfast cereals.

The general idea is that you can easily recognize the amount of sugar in something because it's either commons sense, or there's a label on it.

A drink with two cups equivalent of sugar is "bad". Not because it's inherently negative but because it will affect your blood level fluctuations and the consequence of those fluctuations can be "bad" - you will likely be feeling worse than before you consumed a drink.

An apple is good. Twenty apples might be close to "bad". Do we need to go any further?

Here's a great introduction video by Dr. Berg's video on sugar toxicity where he demonstrates common household products, gives an idea about amount of sugar they contain, and gives recommendations.

Make an effort to switch to complex carbohydrates such as whole grains, fruits, beans, legumes, vegetables. These won't cause spikes in blood sugar levels and contain plenty of other nutrients.

You just need to learn which products contain extreme amounts of sugar. You might want to begin by going through your kitchen and reading labels if you haven't done so.

You need to make a decision. Leaving everything as it is, well, it's also a choice. But it's the one that has brought you where you are right now.

Processed foods and fast-foods. MSG, or Monosodium glutamate-containing foods.

• MSG is a food additive/flavor enhancer that may trigger headaches. MSG is one of the active ingredients in soy sauce, meat tenderizer, Asian foods, and a variety of packaged foods.
• Be aware of labeling such as "hydrolyzed fat" or "hydrolyzed protein" or "all natural preservatives" since these are terms used synonymously with MSG. See this page to learn more
• It's also commonly found in fast foods and commercially packaged food products like chips.
• MSG is present in many of the items on the menu at fast-food restaurants, particularly in chicken dishes.
• MSG is also added to many commercially packaged food products including: Flavored (especially cheese-flavored) chips and crackers, Canned soups, Instant noodles, Soup and dip mix, Seasoning salt, Bouillon cubes, Salad dressings, Gravy mixes or pre-made gravies, Cold cuts and hot dogs, including soy-based (i.e. vegetarian) varieties
• Most symptoms begin within 20 to 25 minutes after consuming MSG. They include: Pressure in the chest, Tightening and pressure in the face, Burning sensation in the chest, neck, or shoulders, Facial flushing, Ringing in the ears, Dizziness, Headache pain across the front or sides of the head, Abdominal discomfort.
  

To be honest, this is something I just cannot understand: why do some of us still eat this "food" that is not really a food? Taste? Price? Convenience?

I know, maybe all of it and more. And I'm not here to judge. I'm here to help and tell you what you already know - processed foods and fast foods are literally poisonous and extremely harmful for your body and mind. Even if you don't see it on the surface, tons of issues are slowly making their way up from the slowly dying life inside your body.

Also, very often processed foods and fast foods are the trigger for headaches and migraines. More importantly, this type of food will slowly break your body and stopping that from happening is pretty much equivalent of a medical emergency treatment procedure. Especially, in case of nerve pain and headaches.

The best approach is to get all you need for self-healing from natural food sources. Eat a variety of vegetables and fats daily as well as cut off all processed foods, refined sugars, and harmful substances such as alcohol and cigarettes.

Even if you cannot stop with refined carbs and processed foods (which is hard, I know, because it's everywhere, including our good memories about it), increase your intake of vegetables and leafy greens. They will slow down insulin manufacturing by your pancreas and decrease spikes in your blood pressure. That would make your headaches less intense.

But please know that you cannot just postpone things that you know harm, damage, and slowly kill you.

This strategy - cut off what makes you sick and eat what makes you healthy - is more efficient than hunting for particular vitamins as supplement (even though they have its place in the recovery process, especially in the beginning).

Remember that taking care of fundamentals (good food in, harmful habits out) are essential for any subsequent treatment to be successful.

Caffeine. A study shows 2 cups is ok but 3 is not. For me, coffee is a no-no when I'm in the middle of a headache. I've experimented countless times with doses and types of coffee (because I love it).

Do your own self-study since it looks like caffeine effects vary from individual to individual.

Another thing is that caffeine speeds up your cognitive capacity which may aggravate your ability to tame your thinking process which in turn may jump into anxious-stress mode without you being able to stop, or derail the process. This might be the beginning of physical response - a headache. I've noticed this exact line of events happening over and over to me.

Note on Hunger. This one is more psychological then physical. The primary cause of your physical symptoms in the stress and anxiety which come from this urge to eat. Yes, it causes blood sugar to drop, resulting in adrenal fatigue and muscle contractions. But more often than not the hunger that people feel is the one caused by other "bad" stuff they consume like lots of coffee, sweets, breads of all kind, processed foods, etc.

So, know yourself. Don't go shopping when you are hungry. Drink more water because often hunger diminishes to the point as it was never there after a glass of water.

Finally, don't stress yourself in the conflict of "I'm hungry" and "I cannot eat". This conflicts kills your mind. Try to close your eyes and breathe deeply for a minute or two. Things will look a bit differently after that. Hunger won't go away and your inner counter-part will be there as well. But you will know that you can find a moment of peace in the middle of an inner storm. That means that you can explore your conscious will even deeper no matter what.

Self-Help: What's next?

As I said above, this section was dedicated only for initial pain relief from headaches, nerve pain, overall soothing your nervous system, and calming your mind.

However, it is a foundation that suppose to remain in place even if you decide to go further.

Pain relief, calming the mind, and elimination of harmful foods will open some space for you to breathe; you will be able to investigate your options in self-healing process.

Unfortunately, those are temporary solutions (even though anti-inflammatory throughout the body) because the roots of our health imbalances are deeper than these surface approaches. Particularly when we talk about issues like headaches and mental overwhelm.

Your way of life - your way of doing things and thinking about them - is what lays at the center. Until you deal with those "hidden" imbalances at the center, you will experience various re-iterations of the same problem on the surface.

It doesn't really matter what you do on the surface because if you don't address your deeper qualities and habits, there's only one scenario - you're going to bring yourself back to the state of painful imbalance.

Sure, it may manifest as another "version" of symptoms you experienced earlier, or it can open a different level of intensity of physical pain and emotional distress.

But the underlying issue will be inevitably pushing itself from the depth to the surface as long as you don't address it directly.

How to do that?

We need to examine our own life, understand new perspectives on things, and gradually make changes.

Unfortunately, there's no quick way. We all know that. We do. But we always hope for something that will make us forget that we know.

You don't have to change everything today or even tomorrow.

You can simply take a birds eye view on the process and decide whether or not you want to follow along.

Let me help you with this.

I've been where you are. I am, in a way, still here.

I know how difficult it may be to deconstruct life brick by brick and slowly introduce even the smallest changes.

I know how to fail. I've done that more than I dare to say. But I also know how to find motivation, inspiration, and forgiveness - to stand up again and again until you catch the wind in your sail.

Let's learn more.

References:

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• Cady, R. K. (2007). "The convergence hypothesis." Headache 47 Suppl 1: S44-51.
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• Piovesan, E. J., et al. (2001). "Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei." Cephalalgia 21(2): 107-109.
• Sahai-Srivastava, S. and L. Zheng (2011). "Occipital neuralgia with and without migraine: difference in pain characteristics and risk factors." Headache 51(1): 124-128.
• Sulfaro, M. A. and J. P. Gobetti (1995). "Occipital neuralgia manifesting as orofacial pain." Oral Surg Oral Med Oral Pathol Oral Radiol Endod 80(6): 751-755.
• Vanelderen, P., A. Lataster, et al. (2010). "8. Occipital neuralgia." Pain Pract 10(2): 137-144.
• Vanelderen, P., T. Rouwette, et al. (2010). "Pulsed radiofrequency for the treatment of occipital neuralgia: a prospective study with 6 months of follow-up." Reg Anesth Pain Med 35(2): 148-151.
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