Knowing Where It Hurts

Jun 25, 2023 at 06:39 pm by pjeter


 Neurologist Oleksandra Dryn specializes in occipital pain blocks




A doctor sometimes can’t put his or her finger on why patients experience shooting, and often debilitating, pain coming from the back of their head.

That’s when a neurologist like Oleksandra Dryn, MD, steps in to literally put her finger on the problem. The physician at the Neurology Clinic in Cordova presses two specific places at the back of a patient’s head. Patients sometimes jump because the condition has made the spots near the base of the skull extremely tender. “This is when you are certain it is occipital neuralgia,” Dryn said. “There are a couple of points where you press the nerve coming out from the neck.”

She’s also decisive about relieving the patient’s pain:  She gives them occipital nerve blocks.

Injecting a combination of steroids and anesthesia into those nerves provides pain relief that lasts two to three months, on average, and for some, up to a year, Dryn said.

She estimates that fewer than 5 percent of her patients require a second injection. “Research shows it’s 15 to 20 percent who need a second injection; in my practice, about 5 percent need a second injection,” she said.

In a 2018 study published in Acta Medica Lituanica, researchers who followed 44 patients with occipital neuralgia found that 95 percent of them experienced satisfactory relief for an average of six months after receiving an occipital nerve block.


Shooting, throbbing, burning …

The trapezoid-shaped occipital bone extends from the top of the neck halfway up the back of the head. The bone’s main functions are protecting the brain and providing a place for muscles and ligaments to attach.

The occipital nerves extend onto the occipital bone from the upper spine. Occipital neuralgia and its excruciating pain occur when those nerves are compressed or irritated.

It’s an intermittent or chronic pain that can be felt on one or both sides of the head. Patients experience a shooting, throbbing, burning or aching sensation that often begins at the head’s base and spreads along one or both sides of the scalp.

Sometimes the scalp is so tender that just a light touch is extremely painful.

Physicians who have patients experiencing such pains should consider referring them to a neurologist, Dryn said. Occipital neuralgia is “hard to recognize sometimes.”

Possible causes may include injury, tight neck muscles, pressed or pinched nerves, or inflammation.

“Sometimes people have symptoms so bad they can’t sleep at night,” Dryn said. “It can be triggered by head movement, or the way they lay down on the pillow in bed.

Other causes can include degenerative changes or arthritis in the neck.

“Some patients experience shooting pains while others might say, ‘I have a headache on the back of my head,’” she said.

It’s not always a shooting pain; it could present differently.

“It’s common, but just not always recognizable, especially by primary care physicians. They tend to think neck pain or headache,” she said.

Dryn estimates she sees three patients a week with occipital neuralgia. Older patients tend to have it more than younger ones.


Under a minute


The occipital nerve block procedure typically takes less than a minute to complete. The anesthetic and steroid are injected into the pain trigger points. While there are three occipital nerves, the procedure usually targets two of them:  The lesser and greater occipital nerves.

The injections are usually well tolerated, like any injection, Dryn says.


Family’s 3rd generation physician


The practice of medicine is in Dryn’s blood. Growing up in Kiev, the capital of Ukraine, she watched both her mother, now a retired neurologist, and her grandmother practice medicine.

“I was just fascinated about patients,” she recalled. “I did play being a doctor when I was little, all the time. It was so natural to me.”

Neurology wasn’t Dryn’s first specialty. After completing medical school in Odessa, Ukraine, in 1997 and her residency in 2001, she worked in Kiev as an ICU attending physician in anesthesia.

Her life took a geographic turn of 5,500 miles 20 years ago. That is when she became a post-doctoral fellow in transplant research, first at the University of Tennessee Health Science Center and then at Methodist University Hospital.

She met her husband in Memphis, married him and decided to stay in the United States, and go through a residency again. “I chose neurology this time. The University of Tennessee (Health Science Center) didn’t have an anesthesia program. And I was interested in neurology since my mom was a neurologist,” Dryn said.

“And I do like procedures; I can do them in neurology.”

Dr. Dryn is among nine physicians and four nurse practitioners at the Neurology Clinic. The practice is just east of Shelby Farms at 8000 Centerview Parkway, Suite 500.

Besides occipital neuralgia, her expertise includes treating headaches and migraines, spasticity and dyskinesia, vascular neurology, neuromuscular disorders, and seizures.

As a team, the Neurology Clinic’s medical professionals encompass specialties that include muscle and nerve disorders, Botox for migraines and spasticity, sleep disorders, seizures, strokes, dementia/Alzheimer’s, and multiple sclerosis.

The clinic uses an on-site MRI scanner and houses a sleep center.