International Journal of Anesthesiology & Pain Medicine

Bilateral Occipital Phenol Neurolysis

Background: Occipital neuralgia is a condition of severe paroxysms of burning; shock like pain in the distribution of occipital nerves and often confused with other causes of headache syndromes like migraine or cluster headache. Relief with local anesthetic block off occipital nerves have a significant diagnostic value.
Case study: A 35 years old female presented with history of episodes of severe shock like, burning pain in suboccipital, frontoparietal region bilaterally and occasionally in retrobulbar region with neck stiffness since one year. She failed to respond to the conservative management, hence given local anesthetic block with steroid of occipital nerves bilaterally on two occasions followed by neurolytic block with phenol at interval of one month. There was reduction in VAS from 9 to <2 at the end of three months. Oral analgesics and anticonvulsants were continued for one month and tapered off over 15 days. On follow up at 6 months and one year she was comfortable with VAS < 2 and no analgesic support needed.
Conclusion: Occipital nerve block with local anesthetic is a diagnostic as well as safe and simple therapeutic option for the relief of occipital neuralgia. Phenol induced neurolysis can be an effective method for long term relief.

Author(s):

Kalpana R Kulkarni

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