Occipital Nerve Block

What is an occipital nerve block?

An occipital nerve block is an injection of anesthetic medication near an occipital nerve to provide temporary pain relief and help inflammation from headaches or other conditions. Sometimes, the injection may also include steroid medication.

Your occipital nerves are a group of nerves in the back of your head. They arise from the C2 and C3 spinal nerves (C is for “cervical” and refers to vertebrae in your neck). There are three types of occipital nerves, including:

• Greater occipital nerve (GON): This is the largest of the three occipital nerves. It provides sensation to the skin of your scalp at the lower back to the top of your head, your ears and the skin above your parotid glands.
• Lesser occipital nerve (LON): This nerve provides sensation to the sides of the back of your scalp, as well as the surface of the visible part of your outer ear (pinna).
• Third occipital nerve (TON): This nerve provides sensation to the skin on the middle lower back of your scalp. The third occipital nerve is vulnerable to damage from whiplash.

Most people have two of each kind of occipital nerve — one for each side of their head.

Even though these nerves supply sensation to specific parts of your head, irritation of or damage to occipital nerves can sometimes make you feel pain elsewhere in or on your head, like near your eye. Healthcare providers call this referred pain.

What does an occipital nerve block treat?

Healthcare providers typically use occipital nerve blocks to help relieve pain from certain types of headaches when other treatment methods haven’t worked. An occipital nerve block can help treat several headache disorders, including:

• Occipital neuralgia.
• Migraine headaches.
• Postdural puncture headache (a complication of a lumbar puncture).
• Cervicogenic headache.
• Cluster headache.

It can also reduce associated symptoms resulting from nerve irritation, including tinnitus and ear pain (otalgia).

An occipital nerve block can also help treat:

• Neck pain you feel in the upper back of your neck.
• Whiplash or related injury.

Your healthcare provider may use an occipital nerve block for diagnostic purposes. It can help them determine if the head or neck pain you’re experiencing is coming from an occipital nerve or somewhere else. This can help them determine the best treatment plan.

How do I prepare for an occipital nerve block?

You usually don’t have to do anything special to prepare for an occipital nerve block.

In some cases, your healthcare provider may recommend sedation for the procedure. If you’re receiving sedation, you’ll need to fast for six to eight hours before it. You’ll also need someone else to drive you home after the procedure if you received sedation.

Your provider will let you know what to do. Be sure to follow their instructions. Don’t hesitate to ask questions.

What happens during an occipital nerve block procedure?

Healthcare providers typically perform occipital nerve blocks for pain management in an outpatient setting. This means you’re not admitted to a hospital for the procedure and can go home shortly after it.

In general, you can expect the following when you receive an occipital nerve block:

• You’ll either sit with your head tilted down supported by your hands or lie on your stomach on a procedure table with a pillow under your chest to slightly flex your neck.
• You may receive a mild sedative through an IV line in your arm to help you relax.
• The provider will feel the back of your neck to locate the targeted occipital nerve. In some cases, they may use imaging techniques (fluoroscopy or ultrasound) to locate the nerve.
• They’ll clean the skin on your neck with an antiseptic solution.
• The provider will inject the medication as close to the affected nerve as possible.
• After the procedure, you’ll rest until the medication takes effect.

The procedure shouldn’t take more than five minutes.

What can I expect after an occipital nerve block injection?

If you had sedation for the procedure, you’ll rest for 15 to 30 minutes after the injection. A nurse will also observe you during this time to make sure you don’t have any unexpected side effects. You’ll then be able to go home.

If you didn’t have sedation, you’ll rest for about 10 minutes and then you can leave.

What are the benefits of an occipital nerve block?

Potential benefits of an occipital nerve block include:

• Temporary or permanent pain relief, which may help you function better day to day.
• Temporary or permanent reduction of inflammation in the affected nerves, which may help them heal.
• Providing a diagnosis of the source of pain.

It’s important to note that not everyone experiences pain relief from nerve blocks. You may need to try other treatment options if this is the case.

What are the side effects of an occipital nerve block?

Common side effects of an occipital nerve block include pain, redness and swelling at the injection site. These are usually mild and go away within a couple of days.

Other side effects may include:

• Dizziness.
• Vertigo.
• Numbness.
• Lightheadedness.

If your injection contains steroid medication, you may experience temporary hair loss (alopecia) and skin thinning (atrophy) around the site of the injection.

What are the risks of an occipital nerve block?

Occipital nerve blocks are generally safe, and complications are rare. But possible risks or complications include:

• Bleeding at the injection site.
• Vasovagal syncope (fainting).
• Facial edema (swelling).
• Worsening headache.
• Temporary difficulty swallowing (transient dysphagia).
• Nerve injury.
• Arterial injury.
• Infection at the injection site.

How long will an occipital nerve block last?

Pain relief from an occipital nerve block varies considerably from person to person. The outcome can be difficult to predict. Successful occipital nerve blocks typically improve pain 20 to 30 minutes after the injection and can last for several hours to several months.

Lasting pain relief for occipital neuralgia and cervicogenic headache can require a series of several injections.

When should I call my healthcare provider after an occipital nerve block?

Contact your healthcare provider immediately if you experience any new symptoms or complications from the occipital nerve block, such as an infection or nerve issues like burning pain, weakness or tingling.

A note from Cleveland Clinic

Occipital nerve blocks can help treat head and neck pain related to headache disorders or injuries. But the results can vary considerably from person to person. If you’re feeling anxious about receiving an occipital nerve block injection, don’t hesitate to ask your healthcare provider about it and the procedure. They can answer any questions you may have.