The term occipital neuralgia was first used in 1821 to describe a characteristic pain in the region innervated by the greater occipital nerve. Since that time numerous authors have failed to reach a consensus concerning the presentation, cause, and treatment of this entity. Review of these previous works reveals that the term occipital neuralgia encompasses a collection of signs and symptoms which develop secondary to a variety of different disease processes. We have treated nine patients suffering from severe occipital pain with associated C2 hypesthesia, unilateral retro-orbital pain, and occipital or C2 tubercle trigger points by intradurally sectioning the C1-C4 dorsal rootlets (C4 if shoulder pain existed). All patients had been treated previously with various modalities without success. This paper discusses the results obtained in these patients.