Occipital neuralgia is a condition of paroxysmal lancinating pain in the distribution of the greater, lesser, or third occipital nerves. It is commonly associated with tenderness over the nerve concerned and is frequently described as chronic, debilitating, and disabling, even with pharmacological treatment. The aim of this chapter is to explore the condition using the available literature to date in order to clarify and distinguish this often overlooked condition as one in its own right. This chapter assesses the available management options and analyzes each individually to provide the clinician with the relevant evidence available to efficaciously guide their practice. The composition of the occipital nerves affected in occipital neuralgia varies between patients; however, the vast majority of cases involve the greater occipital nerve and the literature base reflects this. Most studies and systematic reviews focus solely on this nerve when discussing the condition.