Infiltrative cervical lesions causing symptomatic occipital neuralgia.

[pyomyositis]

Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves , lacking a recognizable local structural aetiology in most cases . Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain , although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord , cervical roots , or occipital nerves have been increasingly reported .We describe two cases (one with typical and another one with atypical clinical features ) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion .We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia , even when typical clinical features are present and neurological examination is completely normal .