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

Abstract

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 4 weeks 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.

Introduction

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 8 days. Our case report received ethical approval from the Ethical Committee of First Hospital of Shanxi Medical University, and the patient provided consent.

Case presentation

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 4 weeks. The skin was disinfected, acupuncture pins (0.35 mm × 40 mm, 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 30 min per session. During the SMA, she did not use any medication.

Fig. 1

Location of structure-based medical acupuncture points needled in a patient with greater occipital neuralgia

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.

Fig. 2

VAS and BRS-6 scores over 4 weeks of SMA treatment in a patient with GON

Discussion

On the basis of inheriting the traditional meridians theory, structured acupuncture and moxibustion proposes theories and therapeutic measures suitable for clinical needs of modern acupuncture and moxibustion. In other words, it is an innovative approach that combines traditional acupuncture with modern medicine, starting with muscles and nerves to determine the treatment site and select the appropriate acupuncture method [13]. As described in the report, the patient had serious pain owing to GON. Although she was admitted to two departments and received both evidence-based medicine and traditional Chinese medicine, the pain did not completely subside. Thus, she was admitted to our department. SMA has no side effects, strong safety, and remarkable curative effect that has been used to remedy numerous ailments [14]. As we have seen, in comparison with medicines, people are more likely to undergo SMA [15]. In this report, the score of primary outcome (VAS) varied from 9 to 1, and the score of secondary outcome (BRS-6) varied from 4 to 1. These outcomes indicate that SMA treatment could be effective for the pain associated with GON. However, our case is also limited by the lack of controlled clinical studies with large samples size to further validate these results. [16].

Conclusions

Our study demonstrates that structure-based medical acupuncture may serve as an alternative short-term treatment for GON pain, with promising potential. However, our case represents only a single example. Therefore, multicenter, large-sample, and controlled trials are needed to further determine whether SMA is superior to conventional acupuncture and has a significant long-term therapeutic effect.