Occipital Nerve Block


Many patients with chronic headache report that their pain arises from the base of the skull. The pain tends to occur on one side or the other and extends forward to involve the temple, the forehead, the eye or some combination of these sites.

Located in the skull base are the occipital nerves. Inflammation/irritation of those nerves may cause a specific type of pain ‘occipital neuralgia’. More commonly however those nerves serve as a site of onset upon which travel the pain signals that produce migraine and other types of headache.

Occipital nerve blocks (ONBs) therefore aim to suppress the pain signal origins of chronic headache.

ONBs may treat a variety of headache disorders and have varying indications. The most common indications include:

  1. Treating an acute migraine attack for rescue purposes
  2. Rapidly suppressing an attack period in cluster headache
  3. Weaning patients with medication overuse off of acute pain medications while prophylactic medications are initiated or escalated
  4. Repeating ONBs in the treatment of chronic daily headache

The procedure typically takes only a few minutes, and patients should have no problem driving afterwards and carrying on with their day. A small needle is used to inject a solution into the area around the nerves. The composition of the solution contains a local anaesthetic drug and a steroid anti-inflammatory drug.

Occipital nerve blocks are safe and well tolerated, and complications are quite rare. Most patients experience head numbness in the distribution of the injected nerve branches. Localised symptoms such as pain or haematoma may occur. Dizziness or blood pressure alterations may occur uncommonly, but are transient. Allergic reactions to local anaesthetic have been described but are rare. Corticosteroid injections may be associated with both local and systemic adverse effects, and your headache specialist will advise regarding these potential issues in more detail.

Pain relief can occur within 15 minutes of the block. For those who experience relief, the duration of the therapeutic response varies widely; for days, weeks or even months.

References: Information for Health Care Professionals, Peripheral Nerve Blocks for Headaches, American Headache Society, Robbins MD et al Occipital Nerve Blocks, Headache, 2010, Rothrock MD

Note: Information on this site is not a substitute for professional medical advice