H7N9 avian influenza with first manifestation of occipital neuralgia:A case report

BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.

Repeat RF Ablation of C2 and Third Occipital Nerves for Recurrent Occipital Neuralgia and Cervicogenic Headaches

Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.

CLINICAL OBSERVATION OF THERAPEUTIC EFFECT ON OCCIPITAL NEURALGIA TREATED WITH DAO FA IN ACUPUNCTURE MANIPULATION

Objective To observe the clinical therapeutic effect of Dao Fa in acupuncture treatment of occipital neuralgia and make the comparison with routine acupuncture. Methods Duo Fa was applied to Tiānzhù （天柱 BL10）, Fēngchí （风池 GB20） to treat occipital neuralgia and compare its results with routine acupuncture. Results The total effective rate was 95.6 % in Duo Fa group, 77.8% in routine group, indicating significant difference （P〈0.05）. Conclusion Comparing with routine acupuncture, Duo Fa is advantageous at selection of fewer acupoints, better therapeutic effect and quicker achievement of efficacy in treatment of occipital neuralgia.

Experience in Acupuncture Treatment of Occipital Neuralgia

Clinically, occipital neuralgia is commonly encountered. It is manifested by pain in the unilateral suboccipital and postmastoid region, which may radiate to the upper occipital part, the ear and copular part, and even to the orbit. The pain is severe, and often cause spasm of the cervical muscles. The authors applied acupuncture for treating occipital neuralgia with good therapeutic results reported as follows.

OnabotulinumtoxinA in the Treatment of Occipital Neuralgia Following Gunshot Injury

Occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.

OnabotulinumtoxinA Nerve Blocks in the Treatment of Occipital Neuralgia

Occipital neuralgia is characterized by severe pain, accompanied by tenderness and trigger points, in the distribution of the greater, lesser, and/or third occipital nerves. Occipital neuralgia is typically idiopathic, but also is characterized as a common form of posttraumatic headache. Typical treatments include nerve blocks with local anesthetic, nerve stimulation, pulsed radiofrequency, and cryoablation. OnabotulinumtoxinA (ONA) has recently been utilized in nerve blocks to treat occipital neuralgia, with the potential for a longer duration of pain relief than local anesthetic. Our study retrospectively examined 63 patients treated for occipital neuralgia, including 19 with ONA. 80 - 155 units of ONA were administered bilaterally in the surrounding musculature. A total of 61 patients, including 17 of those subsequently treated with ONA, were treated with local anesthetic, using a 1:1 mixture of 0.25% bupivacaine and 1% lidocaine, plus triamcinolone. Patients reported VAS pain scores before and after their procedures, and again during 4-week follow-up visits. Information on opioid use, overall pain relief, and duration of full relief was also recorded upon follow-up. Patients treated with ONA exhibited significant decreases in average VAS pain scores from 4.1 ± 2.6 pre-procedure to 2.1 ± 2.4 post-procedure (p = 2 × 10 -5), and 3.0 ± 2.5 4 weeks later (p = 0.0234). Mean overall relief was 75.8% ± 25.0%. Treatment with local anesthetic suggested equally efficacious reduction of VAS scores;however, treatment with ONA showed a significantly higher percentage of overall pain relief leading to follow-up. Opioid use did not exhibit significant change, regardless of treatment type. Our results support the hypothesis that use of Onabotulinum-toxinA in occipital nerve blocks leads to significant decreases in pain, while possibly exhibiting a longer duration of action than that of local anesthetic.

OBSERVATION OF THERAPEUTIC EFFECT ON TREATMENT OF THE GREATER OCCIPITAL NEURALGIA WITH ACUPUNCTURE

To compare the differences in therapeutic effects on treatments of the greater occipital neuralgia between acupuncture and western medicine. Method. Sixty cases of the greater occipital neuralgia were randomized into acupuncture group （30 cases） and western medicine group （30 cases）. In acupuncture group, acupuncture was applied on Fengchi （ 风池 GB 20）, Chengling （承灵 GB 18）, Xuanzhong （悬钟 GB 39） and Ashi （阿是穴）, once everyday. In western medicine group, carbamazepine was administrated orally, 100 mg, Bid × 10 days. Results： In acupuncture group, 25 cases （83.3%） were cured, 4 cases （13.3%） remarkably effective, 1 case （3.4%） effective and 0 case ineffective. In western medicine group, 16 cases （53.3%） were cured, 7 cases （23.3%） remarkably effective, 2 cases （6.7%） effective and 5 cases （ 16.7 % ） ineffective. The cured-markedly effective rates of two groups were 96.6 % and 76.6 % respectively, indicating significant difference between two groups （P 〈 0.05）. Conclusion： The therapeutic effect with acupuncture on the greater occipital neuralgia was significant compared with that with carbamazepine.

ACUPUNCTURE TREATMENT OF OCCIPITAL NEURALGIA WITH DAZHUI AND FENGCHI ACUPOINTS

Objective: To explore therapeutic method for occipital neuralgia. Methods: A total of 90 occipital neuralgia patients were randomly divided into treatment group (n=60 cases) and control group (n=30). In treatment group, Dazhui (GV 14) was punctured and stimulated with reinforcing method, and Fengchi (GB 20) punctured and stimulated with reducing needling method. In control group, the tender point was punctured and stimulated with reducing needling method. The acupuncture needles were retained for 30 min and the treatment was conducted once daily, with 10 times being a therapeutic course. Results: After one session of treatment, the markedly effective rates of treatment and control groups were 98% and 57% respectively. Comparison between two groups showed a considerable difference in the therapeutic effect (P<0.05). Conclusion: Acupuncture of Dazhui (GV 14) and Fengchi (GB 20) are effective in the treatment of occipital neuralgia.

Forty-two Cases of Greater Occipital Neuralgia Treated by Acupuncture plus Acupoint-Injection

Objective:To observe the therapeutic effect of acupuncture plus acupoint-injection on greater occipital neuralgia.Methods:The 84 cases of greater occipital neuralgia were randomly divided into two groups,with 42 cases in the treatment group treated by acupuncture plus acupoint-injection,and 42 cases in the control group treated with oral administration of carbamazepine.Results:The total effective rate was 92.8% in the treatment group and 71.4% in the control group.The difference in the total effective rate was significant(P<0.05) between the two groups.Conclusions:Acupuncture plus acupoint-injection is effective for greater occipital neuralgia,better than the routine western medication.