✓ Occipital neuralgia syndromes have been ascribed to a great many pathological alterations, some demonstrable and some hypothetical. Recently, occipital neuralgia has been attributed to developmental and posttraumatic lesions in the cervicocranial junction region, with the nerve roots at C-1 and C-2 considered to be the principal pain pathways. The authors describe a series of seven patients with an upper neck and occipital pain syndrome due to unilateral degenerative disease (arthrosis) of a C1–2 lateral articulation. Two of the cases are presented in detail. This disease is demonstrable by radiography through the open mouth by isotope bone scanning, and by computerized tomography scanning. Temporary relief may be obtained by anesthetic and steroid injection, and permanent relief achieved by C-2 dorsal rhizotomy.