Occipital nerve block (ONB) is an effective procedure for treating occipital headache pain. However, traditional sub-occipital approaches to ONB remain underutilized in the acute and chronic settings. An alternative location for ONB is the superior nuchal line, where anatomic studies show a reliable relationship between occipital artery and greater occipital nerve. This study evaluated the efficacy and validity of an alternative, single skin insertion, paresthesia-based approach to block both the greater and lesser occipital nerve.

Methods:

Patients with clinical diagnosis of occipital headache were included in this study. External landmarks of cervical spinous process and ipsilateral tragus were used to predict the location of the occipital arterial pulse at the superior nuchal line. Alternative ONB technique was used to block both the greater and lesser occipital nerves using single skin insertion and paresthesia confirmation. Demographic data, Pre- and Post-procedure pain scores, were collected, along with incidence of procedural outcomes, including occipital artery pulse palpation, paresthesia and post-procedure numbness.

Results:

Data were obtained prospectively from 50 patients. Mean pain scores for sample decreased 54.64% post-procedure, P<0.001. Greater occipital nerve paresthesia was confirmed 90.0% on the left (95%CI: 76.3-97.2) and 90.9% on the right side (95%CI:78.3-97.5). Post-procedure numbness in greater occipital nerve distribution was reported 80.6% on left (95%CI:64.0-91.8) and 90% on right (95%CI: 76.3-97.2).

Discussion:

The results suggest that this alternative approach to ONB effectively reduces occipital headache pain and reliably predicts occipital artery pulse and related greater occipital nerve location as confirmed by paresthesia.