CASE PRESENTATION

1. CASE PRESENTATION ON
OCCIPITAL NEURALGIA
R.Anusha
Pharm D VI Year
Roll No:170514882007.

2. Patient name: Mrs.YS
Gender : Female
Age:34 years
IP No:315819
DOA:29/8/19
DOD:30/8/19

3. SUBJECTIVE
• Chief Complaints: Headache since 3 days.
• Present Illness History: Patient presented with complaints of
headache, acute in onset,throbbing, moderate in intensity and
non progressive.Headache was localized to
occipital/posterior aspect of neck.
• No H/o paresthesias in limbs.
• Past medical/medication history: Nil
• Allergies: Allergic to lignocaine and kenacort

4. OBJECTIVE
PHYSICAL APPEARANCE:
Height: 154cms
Weight: 74kgs
B.M.I.: 31kg/m2.
VITALS:
Patient alert, conscious
B.P: 130/80 mmHg.
R.R: 20 breaths/min.
P.R: 89 beats/min.
Temperature: Afebrile

5. 15/15
Pupils :B/L equal and reactive
No gross sensory / motor deficits
Diagnostic test:
CT Scan brain and MRI:-No significant intracanial
abnormality present.
FINAL DIAGNOSIS:
Occipital neuralgia

6. DRUG CHART
Brand Generic Dose ROA Freq. Category Indication
IV Fluid NS 0.9%NaCl 100 ml/hr IV On
flow
Electrolyte Hydration
Inj.PAN Pantoprazole 40 mg IV OD PPI Ulcer
prophylaxis
T.Diclofenac Diclofenac 50mg PO BD Analgesic Pain relief
T.Gabapin Gabapentin 300mg PO BD Anti
convulsant
Occipital
neuralgia

7. Goals of the Treatment
• Treatment is aimed at relieving symptoms.
• To improve quality of life.

8. ASSESSMENT
DAY-1(29/8/19)
• Mrs.YS 34YOF presented with headache more in the
occipital or posterior cervical region.
• She was evaluated for the same.
• Brain imaging with CT scan and MRI did not show any
significant intracranial abnormality.
• She was managed conservately with analgesics and
physiotherapy.

9. • Tab.Diclofenac 50 mg twice daily was given for
symptomatic pain relief.
• Antiepileptic drugs (such as carbamazepine, gabapentin, and
pregabalin), and tricyclic
antidepressants(amitriptyline, nortriptyline), Serotonin and
noradrenaline reuptake inhibitors-SNRIs (Venlafaxine,
Duloxetine) are first line treatment for neuralgia.
• Gabapentin 300 mg twice daily was given for occipital
neuralgia in an effort to decrease frequency and severity of
attacks.

10. DAY-2(30/8/19)
• Her headache subsided significantly.
• She is being discharged in a stable condition.

11. PLAN
MONITORING PARAMETERS:
• Watch for drop in GCS
• Monitor vitals

12. Patient counselling
Disease related
Occipital neuralgia is a condition in which the nerves that run
from the top of the spinal cord up through the scalp, called the
occipital nerves, are inflamed or injured.
Patient might feel pain in the back of head or the base of skull.
• Aching, burning, and throbbing pain that typically starts at the
base of the head and goes to the scalp
• Pain behind the eye
• Sensitivity to light
• Tender scalp

13. • It may be provoked (triggered) simply by touching the
affected region. Activities such as brushing the hair, wearing
a hat, or lying on a pillow may trigger an attack.
• Occipital neuralgia is not a life-threatening condition.
• Most people get good pain relief by resting and taking
medication.

14. Drug related:
 T.Gabapin 300mg 1 tab to be taken orally twice daily after
food for 15 days given for occipital neuralgia.
T.Combiflam 1 tab to be taken orally (if necessary) given for
analgesic affect.
Review after 15 days in neurosurgeon OPD