Efficacy and safety of botulinum toxin injection for occipital neuralgia: a systematic review

Abstract

Background: Occipital neuralgia (ON) is a rare condition characterized by stabbing pain along the greater and lesser occipital nerves. Standard treatments often provide limited relief. Botulinum toxin type A (BoNT-A), previously used for headache, is being explored as a potential treatment for ON. This study aims to assess its safety and effectiveness.

Methodology: A comprehensive literature search was carried out in PubMed, EuropePMC, ScienceDirect, and Google Scholar using keywords such as “Occipital Neuralgia,” “Greater Occipital Nerve,” “Botulinum Toxin A,” “Onabotulinum Toxin A,” “Botulinum Toxin Type-A,” “BoNT-A,” “Botox,” and “Pain,” covering publications up to April 2025. The primary outcome was the Visual Analog Scale (VAS) score, while secondary outcomes included reported adverse events.

Results: This systematic review encompasses six studies with 69 participants. Despite variations in follow-up durations (2, 4, and 12 weeks), all studies reported significant reductions in VAS. Furthermore, no adverse effects related to BoNT-A administration were observed.

Conclusion: In summary, this review indicates that BoNT-A effectively alleviates pain in occipital neuralgia, with benefits observable as early as two weeks post-injection and lasting up to 12 weeks. However, due to variations in dosage, injection techniques, and study methodologies, further well-controlled trials are necessary to confirm its efficacy.

Keywords: Occipital Neuralgia, Botulinum Toxin Type-A, Pain

Citation: Siahaan YMT, Pradhana TM, Arjuna YYE, Hartoyo V, Purnomo AE, Darmawan RO. Efficacy and Safety of Botulinum Toxin Injection for Occipital Neuralgia: A Systematic Review. Anaesth. pain intensive care 2026;30(3):357-364. DOI: 10.35975/apic.v30i3.3175

Recevised: May 29, 2025; Revised: August 29, 2025; Accepted: December 15, 2026