Current RMA Instruments
| 73 of 2025 as amended | |
|---|---|
| 74 of 2025 as amended |
Changes from previous Instruments
ICD coding:
ICD-10-AM: M54.81
Brief description:
Occipital neuralgia is a condition caused by compression and/or irritation to the branches of the occipital nerve, which run from the top of the spinal cord up through the scalp.
Confirming the diagnosis:
Diagnosing this condition involves clinical history and examination findings (i.e. symptoms and signs) consistent with occipital neuralgia.
Neuroimaging, x-ray, and/or ultrasound may often be used to evaluate for potential underlying causes, and to rule out other conditions. Diagnosis can also be supported with a diagnostic occipital nerve block. However, a response may be seen in patients with cervicogenic headache and other headache disorders as well.
To establish the diagnosis, the assessment and/or management requires consultation with a specialist neurologist, neurosurgeon or pain specialist. General practitioners are able to confirm this diagnosis with supportive evidence relating to consistent clinical evaluation and management as well input by the relevant additional specialists involved.
Additional diagnoses covered by these SOPs
- Greater occipital neuralgia
- Lesser occipital neuralgia
Conditions not covered by these SOPs
- Cervicogenic headache #
- Cluster headache *
- Migraine *
- Tension-type headache *
- Trigeminal neuralgia *
* another SOP applies - the SOP has the same name unless otherwise specified
# non-SOP condition
Clinical onset
The clinical onset refers to the earliest point in time, as identified by the treating doctor, when symptoms and signs consistent with the diagnosis of occipital neuralgia were observed, prior to its formal confirmation. Occipital neuralgia results in sharp, stabbing or electric- shock like pain in the back of the head and/or upper neck. These episodes of pain can last a few seconds to minutes.
Clinical worsening
When considering any issues concerning possible clinical worsening, it is important to ascertain whether the clinical worsening is out of keeping with the natural history of the underlying pathology. The causes of occipital neuralgia can also result in clinical worsening of this condition, as well as not being able to obtain appropriate clinical management. Further specialist medical opinion from a neurologist, neurosurgeon or pain specialist would be recommended to address any concerns related to clinical worsening.