Case Diagnosis: 46 Female with ‘Notalgia Paresthetica’ successfully treated with cervical epidural injection and occipital nerve block.
46-year-old female presented to clinic with severe pruritus in her periscapular and occipital region for one year. Pruritus started in the neck and progressed cephalad and caudad with accompanying neck pain radiating down left arm at the time of symptom onset mostly resolved with medrol dose pack and physical therapy. Pruritus persisted and was constant. Gabapentin conferred no relief. Physical exam revealed mild pain with cervical rotation at end range, negative spurlings but with scattered scarring across medial scapular region bilaterally. X-ray showed disc space narrowing at C5-6, MRI showed disc bulging at C4-5, C5-6. Dermatology suspected an allergic reaction with residual irritation; 4 weeks of Allegra was prescribed with minimal relief. Patient then underwent interlaminar C7-T1 epidural steroid injection with significant improvement of pruritus in the scapular region but ongoing symptoms in occipital region. Patient then underwent bilateral occipital nerve block x2 with 70% improvement in symptoms.