Pain Management Procedures
Occipital Nerve Blocks
Occipital Nerve Blocks
What is an occipital nerve block?
The greater and lesser occipital nerves carry feeling from the back and sides of the scalp. When one of these nerves becomes irritated, pain can start near the upper neck or base of the skull and travel over the head. An occipital nerve block places numbing medicine, sometimes with an anti-inflammatory steroid, near the painful nerve.
When may it be recommended?
This block may be considered for occipital neuralgia and selected headache disorders, including some migraines, cluster headaches, and headaches that appear to come from the upper neck. Tenderness over the nerve and the location of the pain help guide the decision. The injection can also provide diagnostic information: meaningful temporary relief suggests that the targeted nerve is contributing to the pain.
What happens during the procedure?
You usually sit or lie face down. The clinician feels for landmarks at the back of the head and may use ultrasound to identify the nerve and nearby blood vessel. After cleaning the skin, a small needle is placed near the nerve and a small amount of medication is injected. The procedure itself is usually brief.
What should I expect afterward?
The back of the scalp may feel numb or heavy for several hours. Relief may begin within minutes from the local anesthetic; any steroid effect generally takes longer. The amount and duration of relief vary widely, from no meaningful change to relief lasting weeks or longer.
Important risks and limitations
Temporary soreness, bruising, swelling, dizziness, or numbness can occur. Less common risks include infection, bleeding, allergic reaction, injury to the nerve, or injection into a blood vessel. A successful block does not cure every cause of headache, and a new, sudden, or neurologically unusual headache needs medical evaluation rather than routine injection treatment.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.