Occipital nerve stimulation for refractory facial pain following occipital pain onset: a case report supporting cervicotrigeminal convergence.

INTRODUCTION: Cervicotrigeminal convergence within the trigeminocervical complex (TCC) provides a neuroanatomical basis for referral of nociceptive input from upper cervical structures to trigeminal territories. However, clinical evidence linking occipital pain onset, trigeminal symptom propagation, and successful treatment with occipital nerve stimulation (ONS) remains limited. CASE PRESENTATION: A 35-year-old woman developed persistent right-sided occipital, retroauricular, and upper cervical pain approximately eight years before presentation, which progressively spread into trigeminal territories. Multiple pharmacological therapies, greater occipital nerve neurolysis, microvascular decompression, and treatments targeting temporomandibular dysfunction failed to provide sustained relief. Following multidisciplinary evaluation, diagnostic greater occipital nerve (GON) blockade resulted in complete temporary resolution of pain. The patient subsequently underwent bilateral ONS, resulting in marked pain reduction (VAS 8-10/10 to 2/10), contraction of the pain distribution, discontinuation of opioid-containing analgesics, and sustained clinical improvement during follow-up. CONCLUSION: This case supports cervicotrigeminal convergence as a plausible mechanism underlying refractory facial pain following occipital pain onset. Complete temporary pain relief after diagnostic GON blockade and sustained improvement following ONS suggest that occipital neuromodulation may represent a therapeutic option in carefully selected patients.