Author: Jenna Fletcher
Medical News Today
The occipital nerve runs from the base of the skull along the back of the head. An occipital nerve block is a procedure to temporarily provide relief from pain related to this nerve, such as that due to certain headache types.
The occipital nerve has three branches. They include:
- the greater occipital nerve (GON)
- the lesser occipital nerve (LON)
- the third occipital nerve (TON)
During an occipital nerve block, doctors typically use medication to block the GON. There are several ways they can do this.
In this article, we discuss an occipital nerve block. We also look at the potential side effects and benefits of receiving one.
An occipital nerve block is a solution that a doctor injects into the area surrounding the occipital nerve. According to the American Migraine Foundation, the solution can vary but will typically contain a mixture of an anesthetic and a steroid anti-inflammatory drug.
The goal of an occipital nerve block is to relieve pain and allow the person to return to normal activities. The steroids in the block may help reduce localized inflammation and may help prevent it from returning.
In a small 2018 study researchers noted that the procedure is simple, safe, and people generally tolerate it well. However, they also state that a person should try other treatment and management techniques before having the block.
In addition, this study involved a total of 44 people in Lithuania, and so the findings may not relate to other populations. Documentation of pain reduction, response rates, and length of relief tend to vary across different studies.
An occipital nerve block procedure can vary depending on the healthcare setting. A person should talk to a doctor about how they will perform the block.
One way a doctor may perform the block is as follows:
- A person remains awake and sitting in an upright position.
- A doctor uses a sterile pad to wipe the area of the injection clean.
- The doctor may numb the skin surface with a local anesthetic.
- After cleaning the area, a doctor uses a small needle to inject the solution into the scalp, near the nerve.
- The procedure takes about 2–3 minutes.
Research suggests there are inconsistencies with:
- how effective each occipital nerve block is at stopping pain
- responses to the medication
- how long the relief will last
The American Migraine Society indicates that a person may feel relief within 15 minutes, but that the length of time they experience that relief could vary from minutes to several months.
According to a 2009 study an occipital nerve block is most effective on the following headache types:
- cervicogenic headache
- cluster headache
- occipital neuralgia
Some evidence also suggests it may help with:
- migraine headaches
- headache pain if other treatment has not been successful
- medication overuse headaches
In rare circumstances, the procedure may be effective for tension headaches.
Researchers consider an occipital nerve block to be a generally safe and well-tolerated procedure. The American Migraine Society says that when an experienced doctor performs the procedure, complications rarely occur.
Some potential adverse effects that can occur due to impairment of the occipital nerve may include:
- trouble speaking
- difficulty swallowing
- numbness of the skin or scalp around the nerve
Additional potential adverse effects or reactions to the procedure may include:
- infection at the injection site
- worsening headache pain
- an increase in pain at the site of injection
The type of headache a person experiences can make a difference in how well the block treats the pain. An occipital nerve block may work well for some people and not as well for others. Here is some evidence on its effectiveness for different kinds of headaches:
According to the American Migraine Foundation, a cervicogenic headache originates in the neck, in or around the cervical spine.
In an older, 2006 study researchers found that people receiving an occipital nerve block noticed symptom relief within 2 weeks. Later research also confirms its effectiveness in treating cervicogenic headaches.
Cluster headaches are a type of primary headache. They often happen in groups or clusters, occurring 1 to 8 times a day. The headaches cause brief, often excruciating pain.
Research has found that an occipital nerve block is often effective in treating cluster headache pain.
According to the American Association of Neurological Surgeons, occipital neuralgia occurs when the occipital nerve is irritated, usually due to injury or illness. The irritation can cause severe, piercing, and throbbing pain in the back of the head, upper neck, or behind the ears.
The organization says nerve blocks are a common, nonsurgical treatment option. Research indicates an occipital nerve block can effectively treat this type of headache.
Migraine is a disabling neurological condition that can cause severe headaches, sensitivity to light, and nausea.
According to a 2020 study, only limited research exists on how an occipital nerve block works on chronic migraine headaches, but what studies exist have presented positive findings. Doctors may eventually recommend a nerve block for migraine headaches, but researchers need to conduct more studies to confirm their findings.
Medicine overuse headache
A medicine overuse headache occurs when a person takes certain medications regularly. The condition is a secondary headache type, which a doctor may refer to as a rebound headache.
A 2018 study suggests that an occipital nerve block could help with medicine overuse headaches. However, the study notes that the effectiveness is not as high as it is for conditions such as cluster headaches or occipital neuralgia.
Before giving a person an occipital nerve block, a doctor will likely recommend several other treatment options as the first line of defense against their pain.
According to one study preventive steps that doctors often recommend include:
- postural adjustment
- physical therapy
- preventive medications such as tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants
- Botox injections
To help relieve an episode of pain, doctors may recommend hot or cold compresses and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
The exact medications a doctor recommends can vary depending on the type of head pain a person experiences. A person should talk to a doctor before starting or stopping a medication.
A person should also consider recording how their pain responds to treatments. This information can be helpful to a doctor and allow them to adjust the treatment plan to help reduce pain.
Occipital nerve blocks are injections that reduce pain and inflammation around the nerve that starts in the base of the skull, which contributes to some types of headache pain. An occipital nerve block is generally safe, but its effectiveness and duration of relief can vary significantly from person to person.
Often a doctor will recommend other treatment options before recommending an occipital nerve block. The procedure itself only takes a few minutes, and a person typically goes home the same day.