Occipital Nerve Block

Unfortunately, many people suffer from chronic headaches and migraines. They report the pain typically starts from the base of their neck moving to the base of their skull. They experience the pain radiating and settling in their temple, top of their head, and their eyes. Sometimes it’s a combination of these locations on the head where pain is felt.  

The base of the skull is where the occipital nerves reside. The nerves on each side of the head emerge between the bones of the spine and upper neck. The occipital nerves make their way at the back your head and into your scalp.  

Irritation of these nerves causes a specific type of pain, classified as “occipital neuralgia.” Responsible for the majority of the physical feelings in the back and top of your head, the occipital nerves emerge between the bones of the spine in the upper neck. Inflammation of these nerves can cause occipital neuralgia (migraines and headaches).  

The irritated occipital nerves can be felt near your eyes and the same side of your head. This type of pain is also known as a type of referred pain.  

Occipital neuralgia can be inconvenient and sometimes debilitating. You may feel unable to move or participate in your daily activities because the pain is incapacitating.  

Occipital nerves blocks can be used to treat and manage chronic headaches and migraines. Some conditions that may benefit from an occipital nerve block procedure are: 

If you are experiencing any of these conditions, an occipital nerve block can help treat and manage your pain. Sometimes blocking the occipital nerve will reduce the headache and its associated symptoms.

What Is An Occipital Nerve Block?  

When discussing your head pain symptoms with your pain management provider, they may recommend a single (or series) of occipital nerve block treatments.  

An occipital nerve block is administered by a physician who is knowledgable in pain management therapy. These physicians include physiatrists, anesthesiologists, neurologists, radiologists, and surgeons.  

It is important to discuss other aspects of your health and medications with your pain management specialist to ensure the most effective results. Some medications, supplements, or vitamins may need to be stopped prior to your procedure due to their potential interactions with the nerve block. 

The ONB injection will contain a steroid anti-inflammatory medication and a long-lasting anesthetic.

What To Expect During An Occipital Nerve Block 

Your pain and back specialist will have you lay on your stomach while they numb the surrounding skin with a local anesthetic. This will help the patient avoid pain during the nerve block procedure. It also can help confirm the source of the pain. 

With fluoroscopic guidance, a needle is guided to the occipital nerves where medication is administered. These nerves are located above the neck area of the back of your head. The entire procedure takes a few minutes where the patient is awake the entire time. You are encouraged to take it easy with rest and relaxation the day of your injection. But patients are able to resume their normal daily activities the next day.  

The administered medication will begin working within 3-5 days. Some patients may even experience immediate pain relief from the anesthetic that turns into longer-lasting pain relief from symptoms.  

The medication can be effective for weeks to months. If you have a positive result from your ONB injection, your doctor may recommend to utilize these injections again if the symptoms return. They may even recommend a series of the injection depending on the severity of your occipital nerve pain.  

Some tenderness at the injection site may be expected. This procedure blocks the pain from the nerves through its “numbing” effect. The steroid injection reduces swelling and inflammation, relieving pressure from the pain originating from the occipital nerves. Treating this irritation and inflammation can also provide relief from the associated pain symptoms.  

While your pain physician may recommend more than one occipital nerve block injection, it is rare to receive more than three ONBs in a six-month period. The more steroid that is injected to a patient, the greater the chance of potential side effects.  

Occipital nerve blocks are a minimally invasive procedure that are generally considered safe. Like any other injection procedure, there are some medical side effects to be aware of. After an ONB, some common side effects are:

If the first occipital nerve block does not provide a successful result in relieving patient pain within the first week or two, it may be necessary to have a second injection. 

If you and your doctor determine that more frequent injections are needed, other treatment options may be considered. These more minimally invasive treatments may include:

It is also important to evaluate if there are a lack of positive results from an occipital nerve block injection. If a patient is unable to find relief from their symptoms, it may be a sign that the occipital nerves are not the source of the pain. If this is the case, our comprehensive pain management specialists will work with you to determine the source of your pain and determine a new treatment course.  

Those who are allergic to steroids or the other medications that are included in the injection should not have an ONB. People who are also on blood thinner or may have an active infection are not appropriate candidates for this procedure.  

Treatment At PASS

In addition to occipital nerve pain and inflammation, Pain and Spine Specialists is able to successfully treat other sources of nerve pain with progressive injection procedures such as ESIs and RFAs. We offer multiple modalities that can be incorporated collaboratively in your pain treatment such as medication management, injections, and alternative therapies.