Arnold’s neuralgia: what do studies really say about the benefits of treatment?

Arnold’s neuralgia is a condition that has received a lot of attention on the French-speaking web in recent years.

However, I haven’t been able to find an article or video based on recent scientific data on this subject, particularly concerning the effectiveness of different treatments, whether physiotherapy or not.

This article is here to remedy that 🙂 !

♻️ Last update: June 24, 2024.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

What is Arnold’s neuralgia?

Arnold’s neuralgia manifests itself as severe downward pain in the back of the head. It is associated with disturbances of sensitivity, particularly to touch, in this area.

Painful attacks usually last only a few seconds or minutes. It may radiate to the front of the head and become more chronic.

Why do they call it that?

This is because the pain is localized in the territory of a nerve called the Arnold nerve, named after the surgeon who discovered it in the 19th century. This nerve is located in the occipital region, towards the occiput, the skull bone at the top of the spine.

The average age of those affected is 50. And it’s the cause of 8 out of every 100 facial pains [Source : Djavaherian 2023].

Why is that?

Several hypotheses have been put forward as possible explanations for these pains.

Arnold’s nerve is quite wide, so it can be quite easily compressed, which can lead to these pains. What can compress it:

• muscular hypertrophy;
• muscle spasms or tension. Hence the fact that this syndrome is often associated with stress and anxiety;
• trauma to the skull or spine;
• Arnold-Chiari malformation or arteriovenous malformations.

[Source: Djavaherian 2023].

How can I be sure it’s right?

As with any pathology, when you consult your doctor or physiotherapist about this problem, he or she will make a differential diagnosis : he or she will rule out other pathologies that could cause similar symptoms, and finally make the diagnosis of Arnold’s evralgia.

Your doctor will also try to determine the underlying cause, even if this is more difficult.

In general, a simple clinical examination and questioning will suffice. In case of doubt, your healthcare professional may prescribe additional tests to rule out other pathologies that could give rise to similar symptoms and require specific treatment.

In 2/3 of cases, pain is present on only one side.

Other pathologies with similar symptoms: migraine, cluster headache, tension headache, continuous hemicrania, non-specific cervicalgia.

Some research teams suggest confirming the diagnosis using nerve blocks: injecting an anaesthetic close to the nerve passage to see if the pain is relieved.

[Source: Djavaherian 2023].

Can it be cured without doing anything?

We don’t have quality data showing the evolution of this syndrome with or without treatment. In particular, because some people do not necessarily consult us for this problem.

My experience has already led me to meet people who have had just one such crisis in their lives (at least, at the time I met them 🙂 ). A crisis that passed without any specific treatment.

So yes, a priori, neuralgia can develop favorably and the pain disappear completely without specific treatment.

What treatments are suggested?

A number of different treatment options are available.

🟦 Let time do its work without any particular intervention, simply by reassuring you.

The pain may eventually pass on its own.

🟦 Introduce conservative treatment : neck immobilization with a cervical collar, physiotherapy sessions, application of heat or cold.

There are no high-quality clinical trials to support the efficacy and side effects associated with these practices.

🟦 Take medications: non-steroidal anti-inflammatory drugs, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, anticonvulsants.

Here again, there are few high-quality clinical trials comparing the effects of these drugs against each other or against a placebo.

Finally, there are slightly more invasive procedures. For each of these, there are clinical studies, rarely replicated and conducted on a small number of people (a dozen or so), without necessarily comparing these techniques with natural evolution.

Potential side effects are also described.

🟦 Ultrasound-guided injections of local anesthetics with a steroid.

🟦 Botulinum toxin type A injections.

Described as having fewer potential side effects than other techniques.

🟦 Destruction of the nerve by thermal radiofrequency (cryoneurolysis).

Potential side effects described:

• sensory disorders ;
• formation of painful neuroma ;
• at temperatures below -70 degrees Celsius, nerve damage is possible.

🟦 Destruction of the nerve by chemical neurolysis with alcohol or phenol.

Potential side effects described:

• sensory disorders ;
• formation of painful neuroma.

🟦 Neuromodulation of occipital nerves using temporary plus implanted nerve stimulators.

Potential side effects described:

• surgical site infection ;
• displacement or fracture of the electrodes or generator after the operation.

🟦 As a last resort: surgical decompression of the nerve.

Potential side effects described:

• intermittent nausea and dizziness ;
• theoretical risk of developing a deafferentation syndrome.

A non-replicated study including 111 patients treated :

• 78 people by radiofrequency denervation ;
• 37 by botulinum toxin injection ;
• 5 by implantation of a nerve stimulation system in 5 cases.

The results show that radiofrequency denaturation produced 89.4% good and very good results beyond 6 months, compared with 80% for botulinum toxin and 80% for nerve stimulation, with two serious complications observed after radiofrequency denaturation: 1 death and one permanent hemiplegia.

Source: Finiels 2016

Are physiotherapy and exercises useful?

Physiotherapy sessions are sometimes prescribed for neuralgia. After an initial assessment, your physiotherapist can help you identify the situations that trigger or relieve the pain.

He or she can also suggest facilities and exercises to help relieve pain, at least temporarily.

There isn’t necessarily a standard exercise : it really depends on your state at the time and how you respond or don’t respond to any manipulations, posutres or exercises.

There is no strong or moderate evidence in the academic literature to support the relevance of physiotherapy, osteopathy, chiropractic, exercise or other manual therapy.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!