Neurology - Occipital Nerve Block

Occipital nerve blocks can be effective at treating some forms of headache and localised scalp pain/tenderness. They can be used in combination with, or instead of oral treatments.

What is an Occipital Nerve Block?

An occipital nerve block is an injection of local anaesthetic next to the occipital nerves, which lie just beneath the skin at the back of the head. Since these nerves are outside the skull, they are easy to locate.

How does it work?

The occipital nerves carry sensation messages from the scalp at the back of the head (the occipital area). In migraine and some other headache types, these nerves can become hypersensitive to pain. Messages from these nerves feed into the part of the brain which is overactive in migraine. Temporarily blocking these messages with local anaesthetic can reduce the over activity and reduce head pain.

The treatment does not cure your condition, but it may lessen the pain for several days, weeks or months.

How long does the injection take?

The actual injection takes only 5-10 minutes to administer.

What is injected?

The injection usually consists of a local anaesthetic (like what your dentist would use). Occasionally a steroid (anti- inflammatory) medication may be added to the local anaesthetic.

The nerve blocks are relatively simple to perform. Your doctor will use a small needle to inject the medication into the area around the nerves at the back of the head.

Will the injection hurt?

Insertion of the needle is not especially painful, but as the medication is injected, some patients may feel mild temporary discomfort or stinging sensation. Once the occipital nerve block is completed, pain relief can happen rapidly, sometimes within a few minutes of the block and can last from days to months.

How is the injection performed?

The procedure is usually performed in a regular examination room and does not require any preparation by you.

You will be asked to sit on a couch or chair with your head bent forward. Your doctor will use a small needle to inject a solution into the area around the nerves. Immediately after the injection the back of your head may feel warm. You may also notice that your pain has gone or lessened considerably.

What should I expect after the injection?

Can I return to normal activities?

Absolutely. You should have no problem driving afterwards and may carry on with your day as you would otherwise.

How long will the effects of the medication last?

The local anaesthetic wears off in a few hours, but the effect on headache relief can last days, weeks or (rarely) months.

Will the occipital block help me?

It is not possible to predict if the injection(s) will help. In our experience about 50% of those selected for injection therapy will notice some improvement in symptoms.

What are the risks and side effects?

This procedure is generally safe. However, like with any procedure there are risks, side effects and the possibility of complications.

The most common side effect is mild discomfort - which is temporary. Since the scalp has many tiny blood vessels near the surface of the skin, some bleeding from the injection site may occur.

Fortunately, the serious side effects and complications are uncommon. As these are sensory nerves, you may experience some temporary numbness over the regions supplied by the nerves.

In exceptionally rare circumstances, patients have reported a small patch of hair loss around the injection site when steroid has been used.

Who should NOT have this injection?

You should not have this injection if you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. warfarin) or if you have an active infection near the injection site.