Korean J Pain.  2010 Mar;23(1):82-87.

Fluoroscopy and Sonographic Guided Injection of Obliquus Capitis Inferior Muscle in an Intractable Occipital Neuralgia

• Kim OS
• Jeong SM
• Ro JY
• Kim DK
• Koh YC
• Ko YS
• Lim SD
• Shin HY
• Kim HK

Abstract

Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles.

Keyword

greater occipital nerve; obliquus capitis inferior muscle; occipital neuralgia

MeSH Terms

Fluoroscopy
Headache
Humans
Muscles
Nerve Compression Syndromes
Neuralgia

Figure

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  Fig. 1 The area about which the patient complains. (A) We can see both Xs of the patient's posterior neck. (B) Right aspect of posterior neck. (C) Left aspect of posterior neck.

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  Fig. 2 Fluoroscopic imaging. Lateral view (A) and anterio-posterior view (B) show spinal needle placement adjacent to the obliquus capitis inferior muscle.

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  Fig. 3 Long axis view - ultrasonographic image of injection in the obliquus capitis inferior muscle. Probe was placed in the midline between spinous process of the axis and left transverse process of the first cervical vertebrae. The arrow shows needle placement in the left obliquus capitis inferior muscle. a: spinous process of 1st cervical vertebrae, b: spinous process of 2nd cervical vertebrae.

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  Fig. 4 Intraoperative picture. The arrow indicates the left obliquus capitis inferior muscle removed during operation.

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  Fig. 5 The pathologic finding of the greater occipital nerve. Degenerated peripheral nerve trunk with axonal swelling and myelin digestion chambers.

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