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The greater occipital nerve arises from between the first and second cervical vertebrae, along with the lesser occipital nerve. It supplies sensation to the skin along the back of the scalp to the top of the head.
Sometimes, when the occipital nerve is irritated, the pain of this irritation is felt near the eye of the same side of the head. This is known as referred pain.
These nerves may also contribute to headaches. Sometimes blocking (numbing) the occipital nerve will reduce headache in the front of the head.
What an Occipital Nerve Block Is
During a nerve block, pain-relieving medicine is injected to the region where the nerve crosses the skull. The patient is usually lying on his or her stomach. The needle is placed near the nerve and the anesthetic (or a combination of anesthetic and steroid) are injected. Pain relief may be immediate and usually lasts as long as the numbness, sometimes the relief may be long lasting.
An occipital nerve block is done to manage:
- Pain that affects the back of the head or one side of the head. People who have sensations of shooting, zapping, stinging or burning pain usually have the best response to the procedure.
Some migraines or cluster headaches
- Spondylosis of the cervical facet joints
- A tender or painful scalp, which may be a sign of an inflamed nerve
The Occipital Nerve Block Procedure
The animation below shows an occipital nerve block being done.
During an occipital nerve block, about a teaspoon of local anesthetic and steroids are injected into the scalp where the trunk of the nerve is. The injection is done at the back of the head, just above the neck. The skin is numbed before the injection is done. A very fine needle is used for the nerve block.
If the injection has been well located, the scalp on that side of the head will go numb quickly. Pain relief can be felt sometimes within minutes. The doctor may ask what the patient is feeling in terms of his or her symptoms.
If there is a lot of swelling in the nerve, the steroids will relieve the pain of that. The full effect of the steroids may not be felt for two or three days. Their effect is more long lasting -- sometimes weeks or months.
After an occipital nerve block, a patient can usually drive home and return to normal daily activities the following day. The effects of the local anesthetic may wear off in a few hours, but the effects of the steroid begin to increase over the next several days.
The best responses to an occipital nerve block usually come from patients whose pain is relatively recent rather than long-standing.
If the first occipital nerve block doesn't relieve the patient's symptoms in a week or two, it may be necessary to have a second injection. Additional nerve blocks may be done to keep the symptoms under control.
On the other hand, a lack of results may be a sign that the occipital nerves are not the source of the pain and further work should be done to diagnose the cause of the pain.
It is rare to do more than three occipital nerve blocks in a six-month period. The more injections of steroids that are given, the greater the chance of side effects. If more frequent injections are needed, another type of treatment will probably be considered.
These might include:
- Cutting a nerve
- Relieving pressure on the nerve
- Killing nerve cells with small doses of a poison or radiofrequency energy
- Inserting an occipital nerve stimulator. This works like a pacemaker in the heart.
Anyone who is allergic to the steroids or other medicines included in an occipital nerve block should not have this procedure. People who are on blood thinners, have an active infection or have poorly controlled diabetes or heart disease should not have an occipital nerve block until their overall health improves.