Occipital Nerve Blocks

What is an occipital nerve block?

An occipital nerve block is numbing of the greater and lesser occipital nerve. The block is an injection composed of an anesthetic and a corticosteroid next to the greater and lesser occipital nerves, which are located just beneath the scalp, superficial to the skull, in the back of the head. It is most often used in the diagnosis and treatment of Occipital Neuralgia and Cervicogenic headache (Afridi 2006). The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the nerves and surrounding structures. Typically, headaches over the back of the head, including certain types of tension headaches and migraine headaches, may respond to occipital nerve blocks.

How is an occipital nerve block done?

This is typically a brief procedure performed without any sedation in the doctor’s office. It is done with the patient seated or lying down. The skin and hair of the back of the head are cleaned with antiseptic solution and then the injection is carried out. A small needle is inserted through the skin beneath the scalp in order to get the numbing anesthetic and corticosteroids around the area of the nerve. The injections block both the greater and lesser occipital nerves.

How effective is an occipital nerve block?

There are two major benefits to using this block. Not only is it useful in treating Occipital Neuralgia, relieving or reducing pain in the back of the head in the scalp, but if symptoms improve after the injection then the block is also useful in diagnosing Occipital Neuralgia. Typically if you respond well to the injection and have pain relief then it is recommended that you return and receive repeat injections. Usually, a series of block injections is needed to treat the problem adequately. However the response to the block varies from patient to patient.

What are the risks?

Generally speaking, this procedure is safe. However, with every procedure there are possible complications. The most common side effect is temporary pain at the injection site. Another frequently seen occurrence is bleeding, since the scalp has an abundance of tiny blood vessels near the skin’s surface. This risk is significantly reduced if ice is placed at the injection site immediately after the procedure. The other less common risks involve excessive bleeding, infection, and nerve damage.

Who should not have an occipital nerve block?

Patients who have an allergy to any anesthetic, are on blood thinning medications, are diabetic, have an active infection, or are pregnant should consult with the pain physician before receiving the procedure. There may be special instructions or lab testing or the procedure might need to be rescheduled.

What happens afterwards?

You will rest for a while in the office. Most patients can drive themselves home. Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have a sore head for a day or two. You should start noticing a more lasting pain relief starting the third day or so due to the steroid’s effect which can last for several days to a few months. We advise the patient to take it easy for several hours after the procedure. You may want to apply ice to the injected area. You can perform any activity you can tolerate. Unless there are complications, you should be able to return to work the next day.

Is an occipital nerve block right for you?

If you experience headaches which typically start in the back of the neck and spread towards the forehead, or have been diagnosed with occipital neuralgia or cervicogenic headache, you may be a candidate for this procedure. Contact us to find out more!

At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.

Journal Article:

Greater occipital nerve injection in primary headache syndromes–prolonged effects from a single injection Afridi SK, Shields KG, Bhola R, Goadsby PJ. Pain. 2006 May;122(1-2):126-9. Epub 2006 Mar 9 PMID: 16527404