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Objective: To compare the differences in therapeutic effects on treatments of the greater occipital neuralgia between acupuncture and western medicine. Method: Sixty cases of the greater occipital neuralgia were randomized into acupuncture group (30 cases) and western medicine group (30 cases). In acupuncture group, acupuncture was applied on Fengchi (风池 GB 20), Chengling (承灵 GB 18), Xuanzhong (悬钟 GB 39) and Ashi (阿是穴), once everyday. In western medicine group, carbamazepine was administrated orally, 100 mg, Bid × 10 days. Results: In acupuncture group, 25 cases (83.3%) were cured, 4 cases (13.3%) remarkably effective, 1 case (3.4%) effective and 0 case ineffective. In western medicine group, 16 cases (53.3%) were cured, 7 cases (23.3%) remarkably effective, 2 cases (6.7%) effective and 5 cases ( 16.7 % ) ineffective. The cured-markedly effective rates of two groups were 96.6 % and 76.6 % respectively, indicating significant difference between two groups ( P ＜ 0.05). Conclusion: The therapeutic effect with acupuncture on the greater occipital neuralgia was significant compared with that with carbamazepine.