What Is An Occipital Nerve Block?

Chronic headaches are very prevalent. Estimates suggest that up to 5% of the global population is affected by this type of pain. For those who suffer from the worst forms of chronic head pain, an occipital nerve block can help them relieve their pain and get back to their life.

Some conditions that are treated with occipital nerve blocks include:

An occipital 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.

In the following video, a chronic pain patient talks about how occipital nerve blocks helped her get back to a normal life.


What Is The Occipital Nerve?

The greater occipital nerve runs from the top of your spinal cord up through your scalp. It travels deep into the muscles around your spine and neck. Then, it becomes superficial just below the superior nuchal line and lateral to the occipital protuberance of your skull.

The lesser occipital nerve is a terminal branch of the superficial cervical plexus. It arises from the second and third cervical nerve roots. It then travels through the muscles near your cervical spine and becomes superficial over the inferior nuchal line of the skull.

Occipital Nerve Block | PainDoctor.com

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.  The occipital nerve block technique is relatively quick and convenient, and is done with minimal invasion (i.e. intrusion into tissues with medical equipment). For the procedure, you’ll be seated or lying down. The injection itself only takes a few minutes, and is done without full sedation.

During the procedure:

  • A local anesthetic may be applied to your skin above the occipital nerve to be targeted in order to avoid discomfort during the procedure.
  • Then, a fine needle (like a hypodermic) is inserted, until it is in an appropriate position near the nerve.
  • Next, steroid medications are injected. These drugs reduce inflammation, and block the transmission of painful signals to the brain, thus inhibiting the sensation of headache pain.

If an occipital nerve block has been successful, you may feel that the side of your head that has been injected has gone numb.  Your physician or pain specialist may request that you stay in the clinic or office for a brief period, during which the actual degree of your pain relief may become apparent.  The time elapsed before you experience pain relief does vary from person to person; it may be nearly instantaneous for one individual, but take a day or more for another.

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.

Are occipital nerve injections safe? 

As John Hopkins notes, occipital nerve blocks are safe procedures, especially so when performed by a highly-trained professional or when compared to surgery.

Occipital nerve block procedures 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
  • Hematoma
  • 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.

Ohio Health also notes that some patients should avoid occipital nerve block procedures:

“If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have an occipital nerve block or at least consider postponing it if postponing would improve your overall medical condition.

Conditions Related To Occipital Nerve Blocks

Occipital nerve blocks are typically used when other treatments have failed to work. They’re most commonly used for severe types of head pain, including:

  • Cervicogenic headaches
  • Occipital neuralgia
  • Migraines

Occipital nerve blocks have had a demonstrable effect on several headache types with pain that originates in the occipital nerve. 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. Occipital nerve blocks are often successful in relieving this pain.  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 lifestyle interventions. 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 an occipital nerve 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.


Migraine headaches are very common and extremely painful and individuals may suffer from migraine pain for up to 72 hours.

These headaches are typically dues by environmental stimuli such as loud noises allergies and stress. It is very important for migraine sufferers to avoid these triggers. In order to be classified as a migraine headache, the patient must not only experience pain for at least four hours but also have sensitivity to both light and sound.

Over-the-counter medications may prove to be effective, but talk to your doctor about occipital nerve blocks if other treatments have failed. Occipital nerve injections can be used to treat patients with the worst migraine pain.

The following video discusses more about migraine headaches. You can also read occipital nerve block reviews from other migraine patients on Migraine.com.

Occipital neuralgia

Occipital neuralgia is a condition associated with damage or dysfunction of the occipital 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 type of pain may also be present as chronic stabbing type of headaches. It can be caused by:

  • Trauma to the head
  • Repetitive neck movements
  • A number other medical conditions

To determine if occipital neuralgia is the cause of your chronic headaches, visit your pain doctor for a diagnosis. While occipital neuralgia is not life threatening, it can be extremely debilitating for those who suffer from this type of pain. With the right diagnosis, the right treatment can be determined, which may include physical therapy, medication, or an occipital nerve block. You can learn more about occipital neuralgia in the following video.



Occipital 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.

If you’re interested in learning more about occipital nerve injections, click the button below to find a highly-trained pain doctor in your area. They can talk about your pain management options, including occipital nerve blocks. With the right pain doctor and the right diagnosis, you can get back to a life without pain.

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  1. 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.
  2. 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.
  3. Anderson JE. Grant’s Atlas of Anatomy. 7th ed. Baltimore: Williams & Wilkins Co.; 1978
  4. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl. 1):1–149.
  5. 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.
  6. Scher A., Stewart W.F., Liberman J., Lipton R.B. Prevalence of frequent headache in a population sample. Headache. 1998;38:497–506.
  7. 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.
  8. Dougherty C. Occipital neuralgia. Curr Pain Headache Rep. 2014;18(5):411.
  9. Voigt CL, Murphy MO. Occipital nerve blocks in the treatment of headaches: safety and efficacy. J Emerg Med. 2015;48(1):115-129.
  10. 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.
  11. Strauss L, Loder E, Rizzoli P. Transient facial nerve palsy after occipital nerve block: a case report. 2014;54(10):1651-1655.