Structure-based medical acupuncture for greater occipital neuralgia: a case report (2025)

Introduction

Greater occipital neuralgia is the syndrome of pain and abnormal sensation in its distribution area caused by anatomical nerve entrapment. Patients with greater occipital neuralgia experience not only limited head and neck movement, but also posterior occipital pain. However, treatment options are restricted and usually linked to adverse reaction.

Case presentation

A 33-year-old ethnic Han woman received structure-based medical acupuncture therapy for greater occipital neuralgia. On the basis of clinical examination, visual analogue scale, and six-point behavioral scale, the patient had rear occipital pain the whole day and felt enormous pressure and was uncomfortable. Visual analogue scale score and six-point behavioral scale score were 9 and 4, respectively. After 4weeks of structure-based medical acupuncture therapy, the patient reported that the symptoms of pain and stress were greatly improved without any discomfort.

Conclusion

Structure-based medical acupuncture could greatly alleviate clinical symptoms in patients with greater occipital neuralgia. Moreover, structure-based medical acupuncture is a safe, accurate, and efficient complementary and alternative treatment.

Greater occipital neuralgia (GON) is a common disease in middle-aged and older people, which is characterized by rapid progression, severe pain, and shorter disease course [1]. Typical symptoms are occipital and rear cranial numbness, pain, as well as limited head and neck movement. Posterior occipital pain is usual complaint in a patient with GON [2]. Previous research has shown treatment with non-steroidal anti-inflammatory drugs, hormones, nutritional nerve drugs, and analgesics [3,4,5]. Evidence-based medicine is the preferred treatment for GON; however, its effectiveness is limited, and prolonged use may lead to drug resistance without addressing the fundamental issue of nerve compression.

Accordingly, green therapy is advisable. Structure-based medical acupuncture (SMA) is based on modern medical theory and has been applied in recent years [6, 7]. SMA is diffusely used in China, and there is growing evidence that it can be effective in the treatment of GON. Nevertheless, to the best of our knowledge, there is a lack of large-scale, authoritative clinical research investigating its therapeutic effects. In this case, a 31-year-old ethnic Han woman with severe posterior occipital pain from GON was successfully cured following SMA for only 8days. Our case report received ethical approval from the Ethical Committee of First Hospital of Shanxi Medical University, and the patient provided consent.

A 33-year-old Han woman with a main complaint of right posterior occipital pain with radiative pain and a cold presented to First Hospital of Shanxi Medical University on 10 January 2024. Present illness: the patient’s family history was inconspicuous, but her previous medical history indicated intermittent headache that lasted 10 years without systemic treatment and she not given a definite diagnosis of GON. On 21 November 2021, she was admitted to the neurology department and the department of Traditional Chinese Medicine of First Hospital of Shanxi Medical University, and was treated with evidence-based medicine containing Gabapentin Capsules, Zolmitriptan nasal spray, and Chuanxiong Chatiaosan. Her improvement in pain symptom was poor. On 7 January 2024, she complained that getting cold was causing the occipital pain to become worse. Her most severe complaint was rear occipital pain the whole day. She felt enormous pressure and was uncomfortable. Consequently, with this diagnosis, a friend recommended acupuncture therapy to her. Then, the patient was admitted to acupuncture outpatient clinic in the hospital for treatment.The relevant physical examination findings: the patient complied with the headache classification committee of the International Headache Society (IHS) the International Classification of Headache (ICHD-3) [8]. According to her symptoms, she was diagnosed with GON.

The treatment of SMA was performed by a sophisticated acupuncture doctor. The acupuncture treatment consisted of was four sessions of acupuncture per week, for 4weeks. The skin was disinfected, acupuncture pins (0.35mm × 40mm, Suzhou Medical Supplies Factory Ltd, Jiangsu, China) were inserted at the outlet of the greater occipital nerve (a), the superior nuchal line between the great occipital nerve and the skull (b), touching obivious myofascial trigger points along the great occipital nerve(c,d), Shuaigu(e), Wangu(f), and Waiguan(g) (Fig.1). The patient was treated for 30min per session. During the SMA, she did not use any medication.

GON was assessed by the visual analogue scale (VAS) and the six-point behavioral scale (BRS-6) [9,10,11,12]. After a week, we observed a downward trend in both VAS and BRS-6 scores; however, the patient still experienced mild pain. (Fig.2). After four weeks of treatment, her GON symptoms significantly improved. During structural acupuncture treatment, no adverse events occurred. Reduced rational symptoms and a comfortable body structure were observed. At the end of the treatment cycle, the the patients underwent telephone follow-up. At 3-months follow-up, she felt physical comfort and stress relief; the GON pain did not relapse.

GON:

Greater occipital neuralgia

SMA:

Structure-based medical acupuncture

VAS:

Visual analogue scale

BRS-6:

Six-point behavioral scale

Author notes

1. Man Li, Xiaoyong Gao, Wenhui Ma, and Peng Gong share first authorship.

Authors and Affiliations

1. College of Basic Medical Sciences, Shanxi University of Chinese Medicine, Jinzhong, China

   Man Li,Peng Gong&Xiaobo Li

2. Acupuncture and Moxibustion Department, The Hospital of Shanxi University of Chinese Medicine, Taiyuan, China

   Xiaoyong Gao

3. Department of Rheumatology and Immunology, The Hospital of Shanxi University of Chinese Medicine, Taiyuan, China

   Wenhui Ma

4. TCM Acupuncture Clinic, First Hospital of Shanxi Medical University, Taiyuan, China

   Yongwang Zhu

Contributions

ML conceived the study and prepared the manuscript; XG conceptualized the research; WM and PG collected and analyzed the data; XL and YZ revised the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Xiaobo Li or Yongwang Zhu.

Ethics approval and consent to participate

The study involving patient/participant was reviewed and approved by the ethical committee of First Hospital of Shanxi Medical University. The patient/participant provided her written informed consent to participate in this study. Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article.

Consent for publication

Written informed consent was obtained from the patient for publication of our case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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