Tinnitus And Occipital Neuralgia: A Documented Tie?

diagram of neck vertebrae

There is a well-documented link between injuries of the head and neck and the development of tinnitus. Although this correlation is common among various types of neck pain and headache disorders, there are specific ties between occipital neuralgia, a disorder affecting nerves in the head and neck, and tinnitus. Can occipital neuralgia lead to tinnitus? First, let’s take a closer look at what the disorder is, and how it impacts nerves.

What Is Occipital Neuralgia?

Occipital neuralgia is a rare neurological condition in which the occipital nerves, the nerves that run from the area where the spinal column meets the neck, up to the scalp at the back of the head, are injured or inflamed. Inflamed nerves can come about as a result of head or neck trauma, and symptoms far exceed the basic headache most people experience from tension or discomfort. Instead, occipital neuralgia can cause shooting, shocking, throbbing, burning, or aching pain and headache that generally starts at the base of the head and spreads along the scalp on one or both sides of the head.

Symptoms Of Occipital Neuralgia

woman in pain holding her neck

Nerves within the cervical spine are responsible for the symptoms of occipital neuralgia. Because nerves are damaged in the cervical spine, it is possible that auditory and somatosensory pathways are also compromised, leading to additional symptoms of occipital neuralgia. These may include:

  • Light sensitivity
  • Dizziness and lightheadedness
  • Vertigo
  • Tender scalp
  • Slurred speech
  • Nausea and/or vomiting
  • Tightness and/or stiffness in the neck
  • Dental pain
  • Blurry vision
  • Nasal congestion
  • Tinnitus
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Pain caused by occipital neuralgia can be felt in the upper neck, back of the head, behind the eyes and ears (usually on one side of the head), the scalp, and forehead. Neck pain can also result, and the damaged nerves can also lead to the development of other conditions, such as temporomandibular joint disorders, tinnitus, and even other headache disorders.

Types And Causes Of Occipital Neuralgia

Occipital neuralgia can either be primary or secondary. A secondary condition is associated with an underlying disease. Causes of occipital neuralgia include:

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

As there are many potential root causes of occipital neuralgia, pain relief efforts can be implemented through various approaches. Some providers may focus on treating the known cause, such as issues related to the cervical spine, in order to potentially treat the cause, while others providers will focus primarily on the pain management aspect. Because nerves are damaged or inflamed, there may not always be a way to effectively treat the cervical spine or the origin of the condition.

Occipital Neuralgia Diagnosis: Process And Outcomes

Occipital neuralgia can be very difficult to diagnose because of its similarities with migraines, neurological disorders, and other headache disorders. The area in which symptoms are experienced can also lead to misdiagnoses like temporomandibular disorders. 

Occipital neuralgia and trigeminal neuralgia diagnoses are comparatively similar in the sense that they both produce painful symptoms ranging in severity. They also share some misdiagnoses, like temporomandibular disorders. They differ, however, in the nerves at the root of the symptoms. Instead of causing pain to the back of the head and scalp, trigeminal neuralgia causes pain in the face. Getting a trigeminal neuralgia diagnosis compared to an occipital neuralgia diagnosis relies heavily on self-report and an evaluation of nerve location.

Occipital neuralgia causes head and neck pain as the occipital nerve is responsible for providing sensations to the scalp, whereas trigeminal neuralgia causes facial pain as the trigeminal nerve is responsible for providing sensations to the face. Identifying the precise area responsible for the pain plays a vital role in receiving a diagnosis.

To diagnose occipital neuralgia, a complete physical and neurological exam, alongside diagnostic imaging will be performed.

A nerve block can also be a helpful tool to confirm a diagnosis. During this procedure, a local anesthetic is administered followed by a steroid drug injection into the occipital region of the head and neck area around the occipital nerves. Patients that do have occipital neuralgia will typically feel an ease of pain and relief from symptoms. The outcome of the nerve block can help providers move forward with a plan of care.

Occipital Neuralgia Treatment

There are different treatments to provide relief for the condition, depending on the etiology of the condition and symptom severity. The presence of other, related conditions can also inform treatment options. Treatment for occipital neuralgia can be done through surgical or non-surgical interventions. These include:

  • Surgical: occipital nerve stimulation, spinal cord stimulation, C2,3 ganglionectomy
  • Non-surgical: heat, physical therapy, oral medications, percutaneous nerve block, botox injections

Is There A Connection Between Tinnitus and Occipital Neuralgia?

The occipital nerves are a group of nerves that arise from the C2 and C3 spinal nerves. They innervate the posterior scalp up as far as the vertex and other structures, such as the ear. Because the greater occipital nerves innervate the skin of the back of the scalp up to the vertex of the skull, the ear, and the skin just above the parotid gland, you can feel a wide variety of symptoms that may not initially all seem to be related.

The lesser occipital nerve divides into medial and lateral segments between the inion and intermastoid line; it enervates the scalp in the lateral region of the head behind the ear and the cranial surface of the ear. As a result, patients may experience pain in or on the ear, and may experience symptoms of subjective tinnitus.

Occipital neuralgia patients are at an increased risk of tinnitus due to inflammation of the occipital nerve at the ear, similar to inflammation of trigeminal nerve from trigeminal neuralgia. Tinnitus intensity can vary, just as occipital neuralgia symptoms vary. The auditory nerve is involved in tinnitus onset, and nerves adjacent to the greater occipital nerves can be impacted.

Research Studies On Tinnitus And Occipital Neuralgia

The tie between the two conditions was identified in one particular case study. The case study and literature review determined that as much as 33% of patients presenting with occipital neuralgia also reported tinnitus. Ultimately, this finding indicated that having occipital neuralgia means an increased risk of also experiencing tinnitus as a symptom.

Occipital Neuralgia Treatments And Tinnitus

Woman holding her head while talking to a doctor

Occipital neuralgia treatment is shown to improve severity of associated tinnitus. Loss of normal hearing can be associated with migraines involving occipital nerve damage, and treating that damage can help reverse the symptoms of tinnitus, or at least limit the extent of symptoms. In some cases, tinnitus symptoms are tied directly to head and neck pain; when a flare-up of occipital nerve pain occurs, a symptom of tinnitus may also occur. From steroid injections to nerve blocks, treating occipital neuralgia can help limit some of the reach of tinnitus symptoms.

One case series found that an ultrasound-guided occipital nerve block reduced otalgia associated with tinnitus. Because occipital neuralgia may play a role in developing and worsening tinnitus and otalgia (ear pain) symptoms, one study evaluated the ability of ultrasound to improve tinnitus symptoms. The study outcomes were positive, and suggested that greater occipital nerve blocks could be a useful and effective treatment option for otalgia and tinnitus patients.

Another study determined that using a nerve block on the greater occipital nerves resulted in over half of all tinnitus patients seeing a reduction in symptoms. This is great news for people seeking largely non-invasive, or non-surgical options to target both occipital nerve pain relief and relief from tinnitus symptoms. By targeting nerves themselves and avoiding more intense interventions like neck surgery, patients can experience relief from head and neck pain and tinnitus.

Other Treatments For Tinnitus

Ringing in the ears can be difficult to contend with, particularly when faced with the prospect of additional aches and pains, or a significantly higher risk for other conditions. Happily, there is a growing body of research that has demonstrated the value of certain tinnitus treatments that can help reduce tinnitus symptoms, even when nerves continue to experience inflammation. These include:

  • Hearing Aids
  • Mental Health Care
  • Medical Care to Address Underlying Conditions

Because tinnitus can be accompanied by other conditions, such as noise induced hearing loss, it is important to take a careful catalog of all ear and auditory related symptoms, to most effectively address the root cause.


Pain caused by occipital neuralgia can be debilitating. Medical research and a systematic review of occipital neuralgia treatments determined that the phantom sound associated with tinnitus also responded to treatment, making it possible to address other symptoms with the most commonly used and safe treatments designed for occipital neuralgia relief. From difficulty with jaw movements, to pain in the inner ear, to tinnitus, occipital neuralgia can affect far more than just the scalp–most often, additional feelings of pain and discomfort in the ears, head, and neck. Fortunately, other symptoms associated with occipital neuralgia typically see relief after neuralgia treatment has begun, and may not go on to experience additional issues like hearing loss and damages to the somatosensory system.  

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