Epidemiology and clinical features of occipital neuralgia: A systematic review and meta-analysis

Background Occipital neuralgia (ON) describes severe, paroxysmal occipital nerve pain. This review synthesizes data on the epidemiology and clinical features of ON. Methods A systematic search of PubMed and Embase databases was conducted from 1988 to 2024. Two investigators independently screened titles, abstracts and full-text articles, and conducted a risk of bias assessment. Meta-analyses were performed using a random-effects model, and between-study heterogeneity was assessed using the I² statistic. Results Fifteen clinic-based studies, comprising 579 patients with ON, were eligible. No population-based studies were identified. Of these, three clinic-based studies examined the relative frequency of ON among adults evaluated for headache or facial pain, with reported rates ranging from 0.6 to 24.4%. Pooled estimates revealed that ON presents in the fifth decade of life and afflicts females (73%). Common clinical features were unilateral pain (81%), a stabbing quality (59%) and severe intensity (54%). Pain affected the greater occipital nerve (98%) with accompanying hypoesthesia (73%). A history of co-existing migraine was common (46%) and a proportion had a history of neck trauma (30%). The between-study heterogeneity was considerable for most clinical features assessed. Conclusions ON shows female predominance and links with migraine and neck trauma. Identified features can aid diagnosis and management, but high heterogeneity calls for population-based research to clarify the epidemiology of ON. Trial Registration: PROSPERO (identifier: CRD42024539063).