Epidemiology and clinical features of occipital neuralgia: A systematic review and meta-analysis

BACKGROUND: Occipital neuralgia (ON) describes severe, paroxysmal occipital nerve pain. This review synthesizes data on the epidemiology and clinical features of ON.

METHODS: A systematic search of PubMed and Embase databases was conducted from 1988 to 2024. Two investigators independently screened titles, abstracts and full-text articles, and conducted a risk of bias assessment. Meta-analyses were performed using a random-effects model, and between-study heterogeneity was assessed using the I² statistic.

RESULTS: Fifteen clinic-based studies, comprising 579 patients with ON, were eligible. No population-based studies were identified. Of these, three clinic-based studies examined the relative frequency of ON among adults evaluated for headache or facial pain, with reported rates ranging from 0.6 to 24.4%. Pooled estimates revealed that ON presents in the fifth decade of life and afflicts females (73%). Common clinical features were unilateral pain (81%), a stabbing quality (59%) and severe intensity (54%). Pain affected the greater occipital nerve (98%) with accompanying hypoesthesia (73%). A history of co-existing migraine was common (46%) and a proportion had a history of neck trauma (30%). The between-study heterogeneity was considerable for most clinical features assessed.

CONCLUSIONS: ON shows female predominance and links with migraine and neck trauma. Identified features can aid diagnosis and management, but high heterogeneity calls for population-based research to clarify the epidemiology of ON.Trial Registration: PROSPERO (identifier: CRD42024539063).