A Rare Case of Occipital Neuralgia Secondary to Ball Bullet Gunshot Wound

Introduction

Occipital neuralgia (ON) is a rare cause of headache characterized by severe episodes of lancinating pain within the distribution of the greater and lesser occipital nerves [17]. This paroxysmal jabbing pain may be associated with aching in the greater or lesser occipital nerve distributions between paroxysms. Often there is tenderness over the nerve and sometimes there can be diminished sensation or dysesthesia in the distribution of the nerve [12]. Although specific causes such as whiplash injury, prior skull base surgery, rheumatoid arthritis, nerve entrapment by hypertrophied atlantoaxial ligaments, compression of the greater occipital nerve by an anomalous ectatic vertebral artery, and degenerative C1-C2 arthrosis are reported, the majority of cases are idiopathic [8] [11]. A wide variety of treatments have been tried, including cervical collars, transcutaneous nerve stimulation [15], analgesics and antimigraine drugs [9] [18], occipital nerve block with or without glucocorticoid injection, chemical or radio-frequency occipital nerve ablation [19], atlantoaxial arthrodesis, and dorsal cervical rhizotomy [16], all with variable degrees of success. We describe a unique case who presented with occipital neuralgia after being shot by a ball bullet (BB) which was accidentally fired from a BB gun close to the face.

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