FAQs on Occipital Nerve Block

Around 5% of the world’s overall population report having some type of headache pain. While not everyone has persistent, recurrent headaches, many people do suffer with head pain. The occipital nerve block is a special procedure used for the treatment of chronic head pain, particularly occipital neuralgia.

How does the occipital nerve block work for pain?

Injecting the occipital nerves at the posterior (back) of the head inhibits pain signal transmission. These blocks are used for people who do not respond to medications and conservative treatment efforts. Pain of the neck and head often radiates outward and to the posterior skull region.

What conditions respond to the occipital nerve block?

The occipital nerve block works for many types of headaches, neck pain, and head pain. These conditions include:

  • Occipital neuralgia – This headache produces stabbing pain at the back of the neck and head. Many patients report tenderness of the posterior region of the head.
  • Episodic cluster headache – With these headaches, pain occurs around or in the eye region. Cluster headaches occur in clusters, with pain occurring 1-2 times daily for a period of 4-6 weeks.
  • Chronic migraine – These headaches cause severe pain all over the head. Often occurring in response to certain triggers, associated symptoms are dizziness, visual disturbances, nausea, and vomiting.
  • Cervicogenic headache – Associated with trauma to the neck or posterior head region, these headaches are triggered by neck movement, which causes pressure on the occipital nerves.
  • Tension-type headaches – As the most common type of headache, these headaches cause a band-like squeezing sensation, with pain at the front and back of the head.
  • Occipital nerve inflammation – Injury, trauma, and overuse can lead to inflamed occipital nerves and recurrent pain at the posterior of the head.
  • Spondylosis of the cervical (neck) facet joints – The tiny joints along the back of the cervical spine are called facet joints. With age and wear-and-tear, these joints lose cartilage and become inflamed.

How is the occipital nerve block performed?

The occipital nerve block is a simple procedure done at the doctor’s office. No sedation is required, and there is no preparation necessary. If you are taking blood-thinners, be sure to make the doctor aware of these. In addition, notify the doctor of all your medications and current health conditions. A small needle is used to numb the posterior pain with a local anesthetic. Using another fine needle, steroid agents and/or a long-acting anesthetic is instilled onto the occipital nerves.

How will the occipital nerve block feel?

You will feel a pinch and slight burning when the skin and deeper tissues are being injected. After the procedure, the back of the skull may be slightly tender and sore. Immediately after the procedure, a nurse monitors you for around 20 minutes, and we recommend you rest for the remainder of the day.

Will I need more than one occipital nerve block?

Depending on your condition, and how you respond to the occipital nerve block, the doctor may recommend additional procedures. Immediate effects are attributed to the local anesthetic, and it takes around 3-5 days for the corticosteroid to work. Many patients enjoy pain-free intervals of 1-3 months. If you have no improvement within 2 weeks, the doctor may recommend another occipital nerve block. Most patients receive a series of three blocks over a 6-12 month interval.

Does the occipital nerve block work?

According to a recent study, the occipital nerve block offered complete pain relief for almost half of the patients, and most all patients reported some benefit. In other clinical trials, the success rate for the occipital nerve block was 85-95%, with results lasting for 2-6 months.

Resources

Afridi S, Shields K, Bhola R, et al. (2006). Greater occipital nerve injection in primary headache syndromes: Prolonged effects from a single injection. Pain, 122:126–129.

Ambrosini A, Vandenheede M, Rossi P, et al. (2005). Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: A double-blind placebo-controlled study. Pain, 118:92–96.

Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Repetitive occipital nerve blockade for cervicogenic headache: Expanded case report of 47 adults. Pain Pract. 2006;6:278–284.

Peres MFP, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SB. Greater occipital nerve blockade for cluster headache. Cephalalgia. 2002;22:520–522.

Young WB, Marmura M, Ashkenazi A, Evans R (2008). Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache, 48:1122–1125.