A study was conducted to identify differences between patients with isolated occipital neuralgia (ON) and patients with ON who also had migraine headache (ON+M). Very little is known about the pain characteristics and associated features of patients with these headaches.

As reported in Headache, January 2011, 35 patients were studied, all of whom met diagnosis criteria of International Headache Society for ON. There were no differences between the groups for age, gender or ethnicity.

Patients with ON+M had significantly more complaints of pain traveling to the scalp and presence of scalp tenderness and tingling compared with patients with isolated ON. 25% of the ON+M patients described pain as dull whereas the ON group reported sharp and shooting pain.

The majority of patients in both groups reported pain in the neck and shoulder. 55% of patients in the ON+M group and 60% in the ON group reported an extremely tender sore point in their upper back next to the shoulder blades on the same side as their headaches. There may be significant differences in pain characteristics for patients with ON+M and those 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 with isolated ON include differences in treatment regimen, avoidance of inappropriate use of medical resources, and differences in long-term outcomes. This study serves as a reminder that several types of head pain may coexist in a headache patient, and it is important to separate each element to tailor treatment for individual patients.

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