Disclosures: Martin D. Laguerre, MD, MPH: No financial relationships or conflicts of interest

Case Diagnosis: Occipital Neuralgia

Case Description: A 28-year-old professional baseball player sustained a concussion from a collision at home plate. The patient complained of anterograde amnesia and feeling significant mental fogginess. After essentially maintaining bed rest for 2 d, he experienced severe cervical pain and a bout of emesis during ambulation. Subsequent computed tomography (CT) imaging of the cervical spine was normal. On examination, his cervical range of motion was limited to the left more than the right and his neck pain and limited range of motion gradually resolved over 2 months. Despite this, he was unable to resume any physical activity due to the development of a severe sharp, stabbing, and throbbing headache located in the left occiput. Triggers included the resumption of any athletic activity, but he found that he could avoid triggering headaches by looking straight ahead. A follow-up physical examination was significant for tenderness in the left occiput at the craniocervical junction. He was diagnosed with ON and was referred to interventional pain management for a left cervical medial branch block of C2 to C3 and third occipital nerve (TON) blocks. These procedures provided 100% pain relief and greatly increased cervical range of motion. He was then able to complete a graded return to play protocol successfully and resumed baseball.

Setting: University Academic HospitalAssessment/

Results: Positive response to occipital nerve block.

Discussion: Occipital neuralgia (ON) is an often-undiagnosed cause of head and neck pain. Potential etiologies of ON are wide and include head and neck trauma, such as whiplash and concussion injuries, atlantoaxial joint instability, or as a complication after radiofrequency ablation.

Conclusion: Occipital nerve blocks can be efficacious in treating patients with ON. For those patients with a positive but temporary response to the block, radiofrequency ablation of the third occipital nerve commonly results in more sustained improvement.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/occipital-nerve-block-for-the-assessment-of-delayed-recovery-from-concussion/