Occipital neuralgia secondary to respiratory tract infection.

Occipital neuralgia is an extracranial pain that may be confused with other headaches. It can be attributed to multiple causes. The authors report the case of a 55-year-old woman suffering from right occipital neuralgia secondary to respiratory tract infection that began 6 days before the pain started. The patient suffered from a sharp and burning pain with paroxysms in the right occipital region and at the top of the right ear. Sensation was decreased in the affected area, and hypersensitivity to touch and cold water was also noted. Tinel's sign was present, and local anesthetic block produced pain relief. The combination of gabapentin and amitriptyline did not provide significant pain relief but led to marked adverse effects. Carbamazepine (300 mg/d) was required for pain control. A month later the patient appeared totally pain-free. The treatment was continued for 3 months, and the patient remained pain-free over a subsequent follow-up period of more than 6 months. Thus, in the case of occipital pain, a careful assessment of symptoms and a thorough history are necessary to obtain the correct diagnosis and to choose the appropriate treatment plan.