The International Headache Society (ICHD-II) criteria [11] for ON includes: (1) paroxysmal stabbing pain, with or without persistent aching between paroxysms, in the distribution(s) of the greater, lesser and/or third occipital nerves; (2) tenderness over the affected nerve; and (3) pain eased temporarily by local anaesthetic block of the nerve.
In the ICHD-II classification [7] the following diagnostic criteria are required for occipital neuralgia: (a) paroxysmal stabbing pain, with or without persistent aching between paroxysms, in the distribution(s) of the greater, lesser and/or third occipital nerves, (b) tenderness over the affected nerve and (c) pain is eased temporarily by local anaesthetic block of the nerve.
Occipital neuralgia is defined as a paroxysmal stabbing pain in the distribution of the greater, lesser and/or third occipital nerve with tenderness over the affected nerve.
Pressure is exerted on the surrounding tissues, muscles and nerves, creating tenderness.
After the greater occipital nerve was located, local tenderness was evaluated bilaterally.
First, we did not perform nerve block or examine tenderness in the occipital area to diagnosis occipital neuralgia (ON).
One of the clinical predictors for the effectiveness of a greater occipital nerve block is local tenderness over the area of the GON [21], hence both techniques, palpation of the GON and manual joint examination might identify the same subpopulations of migraine patients and might therefore be useful for the choice of the most promising treatment approach.
The physical examination included an assessment of the following items: Isometric strength in ten upper limb muscles; sensibility in five homonymously innervated territories; and the presence of abnormal tenderness along nerve trunks at 14 locations.
Other symptoms might be dizziness, tingling sensation, inflammation of the nerves causing pain and tenderness and loss of function of muscles.
These could be more likely causes, the later can affect the tibial nerve functions to give numbness, tenderness, and weakness of the muscles and tendons, but these symptoms would be felt at the whole foot area, and in the toes too, not only under the heel like in plantar fasciitis.
