What Is An Occipital Nerve Block?Chronic headaches have become very prevalent. Estimates suggest that up to 5% of the global population is affected by this type of pain. Examples of this condition include:
- Chronic migraine
- Episodic migraine
- Chronic cluster headaches
- Episodic cluster headaches
- Tension-type headaches
- Occipital neuralgia
Occipital neuralgia is a condition associated with damage or dysfunction of the occipital nerves. These are important cranial nerves. The symptoms of this condition may include a dull, throbbing pain mainly confined to the back of the skull or top of the neck.
This condition may be treated with an occipital nerve block. A nerve block is a minimally invasive intervention available to patients with moderate to severe chronic neuralgia, or other type of headache associated with the occipital nerve. These may include types of pain that start at the back of the head near the neck, and then radiate outward throughout the skull. An occipital nerve block inhibits or blocks the disproportionate or chronic signals that are sent to the brain, processed and perceived as headache pain. Occipital nerve blocks may result in pain relief lasting up to several months, depending on the response of the individual patient to this treatment.
How Is An Occipital Nerve Block Performed?An occipital nerve block is a safe procedure that may be performed in a doctor’s office or pain clinic. It is relatively quick and convenient, and is done with minimal invasion (i.e. intrusion into tissues with medical equipment). A local anesthetic may be applied to the skin above the occipital nerve to be targeted in order to avoid discomfort during the procedure. A fine needle (like a hypodermic) is inserted, until it is in an appropriate position near the nerve. Medications, which are most usually steroids, are injected. These drugs block the transmission of painful signals to the brain, and thus inhibit the sensation of headache pain.
If an occipital nerve block has been successful, the patient may feel that the side of the head that has been injected has gone numb. The physician or pain specialist may request that the patient stay in the clinic or office for a brief period, during which the actual degree of pain relief may become apparent. The time elapsed before the desired effect may vary from person to person; it may be nearly instantaneous for one individual, but take a day or more for another.
Occipital nerve blocks may result in side effects such as tenderness and discomfort in the area in which the injection has been administered. However, the steroids administered should inhibit any pain linked with this.
Other common side effects of nerve blocks may include:
- Slight bleeding or infection at the injection site
- Adverse reactions to steroids, which may include swelling, discoloration of the skin of the injection site, and emotional disturbances
- Adverse reactions to local anesthetics, including temporary acute headache, nausea, chest discomfort, and sensory abnormalities
In rare cases, neurological complications such as facial palsy (the reduced ability to move and control the muscles of the face) may occur as a result of an occipital nerve block. However, this is temporary and should resolve itself within about five hours of the procedure.
An occipital nerve block does not often interfere with normal function or routines following a procedure. The patient may not notice the full effect of the intervention until a few days after the procedure. This may last a month or more, at which point the patient may arrange for a repeat injection. However, some patients may require two injections in quick succession to elicit an optimal effect.
Conditions Related To Occipital Nerve BlocksOccipital nerve blocks have had a demonstrable effect on several headache types. These may be associated with throbbing pain, and also with sharper types of pain, pain that appears to reverberate through the skull, and with headaches that are perceived as a burning pain. These conditions are generally linked to pain that originates in the occipital nerve. Occipital nerve blocks are often successful in relieving this. However, they may be less effective in patients with long-term conditions that have not been diagnosed or treated adequately.
Occipital nerve blocks are recommended to patients with moderate to severe chronic pain that has not responded to conventional treatment such as oral painkillers, or more advanced options, such as opioid therapy. Those whose pain is associated with head trauma may also be candidates for this line of treatment. A recent clinical trial demonstrated the efficacy of occipital nerve block in chronic cluster headache. 42% of the patients in this study were completely free of pain after the procedure, and the effects lasted for up to 504 days.
Occipital nerve blocks may also be used in diagnosing one of these headache types. A physician may perform a block to assess its effect on a patient with suspected occipital neuralgia, or a similar condition. If a positive response within expected therapeutic parameters is elicited, it is probable that the patient does indeed have a condition associated with the occipital nerve.
ConclusionOccipital nerve blocks are treatments associated with positive effects in chronic headache types that appear to originate in the base of the skull. These procedures are relatively simple, non-invasive, and convenient, and may be performed in a pain specialist’s office or clinic. Occipital nerve blocks may be suitable for patients with chronic treatment-resistant headache, pain associated with head injury, or other types of occipital neuralgia. An occipital nerve block may take effect immediately after a procedure, or a few days afterward, and remain effective for a month or more.
- Afridi S, Shields K, Bhola R, et al. Greater occipital nerve injection in primary headache syndromes: Prolonged effects from a single injection. Pain. 2006;122:126–129.
- Ambrosini A, Vandenheede M, Rossi P, et al. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: A double-blind placebo-controlled study. Pain. 2005;118:92–96.
- Anderson JE. Grant’s Atlas of Anatomy. 7th ed. Baltimore: Williams & Wilkins Co.; 1978
- Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl. 1):1–149.
- Magis D, Gerardy PY, Remacle JM, Schoenen J. Sustained effectiveness of occipital nerve stimulation in drug-resistant chronic cluster headache. Headache. 2011;51(8):1191-201.
- Scher A., Stewart W.F., Liberman J., Lipton R.B. Prevalence of frequent headache in a population sample. Headache. 1998;38:497–506.
- Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache. 2008;48:1122–1125.
- Dougherty C. Occipital neuralgia. Curr Pain Headache Rep. 2014;18(5):411.
- Voigt CL, Murphy MO. Occipital nerve blocks in the treatment of headaches: safety and efficacy. J Emerg Med. 2015;48(1):115-129.
- Lambru G, Abu Bakar N, Stahlhut L, et al. Greater occipital nerve blocks in chronic cluster headache: a prospective open-label study. Eur J Neurol. 2014;21(2):338-343.
- Strauss L, Loder E, Rizzoli P. Transient facial nerve palsy after occipital nerve block: a case report. 2014;54(10):1651-1655.