A positive response to a nerve block is generally considered to be diagnostic for a given neuralgia, but a negative response doesn't rule out neuralgia. In many (most?) cases of neuralgia, diagnosis is made by considering the characteristics of the pain and then ruling out known diseases/disorders. This is especially true if imaging studies (X-Ray, CT, MRI, etc.) are inconclusive.
I wish you all good luck. My occipital neuralgia is currently being "controlled" by duloxetine (Cymbalta,) which is to say that the severe stabbing attacks are very infrequent. There is a constant pain of about 3 - 4 on a pain scale from 0 (no pain) to 10 (worst pain imaginable,) with occasional pain excursions to 7 - 8 every other day or so. My pain management is not great, but it's MUCH better than the knife pain / electrical shock episodes that used to occur several times a day.
Originally Posted by fedup76
My pain is typically on the right side just behind the ear and around that area. What I experience is "knife stabbing" pain every 30 seconds to a minute. The pain is absolutely excruciating. The bout lasts anywhere from 3-10 days. It is the most awful thing to go through. As well the right side of my face is very sensitive during this time. When I was diagnosed, I was told that there are no "tests" that can diagnose this, it is diagnosed solely through symptoms. I'm not sure if things have changed now though. It's something that to my knowledge doesn't have a cure and is something I have to live with for the rest of my life. Fortunately, the bouts come randomly, about once a year, although this year I have had it twice already. I wish you luck.