What Is Occipital Nerve Block?

Introduction

More than 15% of the population suffer from severe headaches and approximately 1.4% to 2.2% of headaches last 15 days a month.¹ Due to the sevee impacts of this condition, both physically and socially, healthcare providers may recommend an occipital nerve block to manage headaches. An occipital nerve block is an anaesthetic injection administered near the occipital nerve, whichnumbs the area and provides temporary pain relief to helps inflammation.² There is one of each occipital nerve on either side of the head, running between the bones of the spine in the upper neck.³ These two major nerves then run through the muscle at the back of the head and through the scalp. When this treatment is successful, it can supress pain for periods between several hours and several months, improving patients’ quality of life.²

Occipital Neuralgia

Anatomy of Occipital Nerves

There are three types of major occipital nerves in the body. These include:⁴

• Greater Occipital Nerve - this is the largest occipital nerve.. It pierces  the skin at the back of the scalp, then travels through the skull, ear and to the parotid gland (a pair of salivary glands located in the front of each ear).
• Lesser Occipital Nerve - this splits up into three and goes through the scalp, behind the ear and through to  the outer ear.
• Third Occipital Nerve - this goes through the middle, lower back of the scalp.

When these nerves are inflamed or injured, it can cause pain and headaches as a result of a neurological condition called occipital neuralgia. This is characterised by a throbbing pain and burning sensation at the back of the head and along both sides of the scalp.⁵ Pain is felt in the:

• Forehead
• Scalp
• Behind the eyes and ears
• Upper neck
• Back of head

Causes

Causes of occipital neuralgia include:

• Injury
• Pinched nerve
• Tight neck muscles
• Nerve compression
• Disc disease
• Infection and inflammation

Management

Some of the first-line treatment options for occipital neuralgia can include:⁶

• Rest 
• Massage
• Cold/hot compress
• Physical therapy

However, if these methods are unsuccessful, second-line treatment is available, such as an occipital nerve block. This is the injection of a steroid and local anaesthetic. 

The Occipital Nerve Block Procedure

Preparation for the procedure

If you consume regular medication, you are usually able to continue taking it. However, if you take anticoagulants (to prevent blood clots) or blood thinning medication, you must notify your doctor, as you may have to stop taking these at least 1 week prior to the occipital nerve block.⁷ It is also advised to follow the following guidelines before your procedure:⁸

• Do not eat or drink anything 6 hours before
• Make sure someone accompanies you to and from the hospital
• Allow for plenty of time, as the procedure and waiting time can last 2 to 3 hours 

Steps of the procedure

During the procedure, an intravenous line is placed in your hand, to provide you with medicine to help with anxiety and pain relief.⁹ There is careful monitoring of the heart, blood pressure and pulse throughout. 

A small area of your skin will be cleaned with an antiseptic, after which a local anaesthetic will be administered to the skin in order to numb the area. The medication is then injected into the occipital region, which lasts less than 10 minutes. 

Post-procedure recovery

After the procedure, you will be monitored for 30 to 40 minutes, and will be discharged if deemed fit.¹⁰ It is strongly advised to:¹¹

• Avoid driving or operating heavy machinery for 24 hours after the treatment
• Avoidtaking a bath or going to the pool for 24 hours after the treatment
• Wait three days after the treatment before going back to physical therapy 

Side effects and complications

Some side effects after this may include:²

• Pain, redness and swelling at the injection area
• Vertigo (dizziness)
• Numbness
• Light-headedness
• Alopecia (hair loss) and atrophy (skin thinning) around the injection site - this only occurs when the injection contains a steroid

There are various groups of people who are at a higher risk of these side effects including::

• Diabetics
• Allergic to steroids
• Patients who take blood-thinning medicine
• Those with a heart condition
• Those who have an infection 

Although this procedure is safe and complications are rare, there are some risks to consider:

• Bleeding at injection area
• Fainting
• Facial swelling
• Worse headache
• Difficulty swallowing
• Nerve injury
• Arterial injury
• Infection at injection area

Results can vary between individuals, but if you experience any complications or unusual symptoms, such as an infection, burning, pain, or weakness after the treatment, please contact your doctor immediately.

Indications for Occipital Nerve Block

This procedure is typically recommended for patients who suffer from certain types of headaches when other treatment options have not worked.² The conditions where this treatment would be beneficial include:

• Occipital neuralgia
• Migraine headaches - this is when there is a throbbing sensation on one side of the head, and is considered a neurological disease¹²
• Postdural puncture headache - a complication from a lumbar puncture (a procedure in which a needle is inserted into the lower back to collect cerebrospinal fluid)¹³
• Cervicogenic headache - a neck problem which creates head pain¹⁴
• Cluster headache - this causes severe one-sided pain and can happen up to eight times in a day¹⁵

An occipital nerve block can reduce symptoms which occur as a result of nerve irritation, and can also treat:²

• Upper neck pain
• Whiplash

An occipital nerve block can also be used for diagnostic purposes, as it can help determine if the pain from the neck or head is coming from the occipital nerve or another area.

Evaluation and Diagnosis

Adoctor might diagnose you with occipital neuralgia by first using a physical examination to locate the area of sensitivity around the occipital nerve.³ If the occipital nerve block procedure is successful, it may confirm the location of the neuralgia, after which a more permanent treatment can be administered if the problem persists. 

Efficacy and duration

Some patients may need more clarification about the success rate of this procedure. However, 95.45% of those who were administered with a local anaesthetic and corticosteroids reported a satisfactory result for a minimum of 6 months.¹⁶

The local anaesthetic will last for 4 hours after the procedure, sothe pain may heighten until the steroid starts to work, which can take up to 2 weeks.¹⁷ The pain relief provided by the occipital nerve block will last a few months but this may vary between each patient. It is possible to get 3-4 injections per year to subside the pain. If there is no pain relief after this, it is possible that the occipital nerve is not the issue and your doctor will help you find the source and cause of your pain, in order to find a suitable treatment. 

Alternative treatments

There are other treatments which can provide pain relief, including:⁶

• Local anaesthetic agent injection
  • Blocks the sensory signals from the area that is injected. 
  • Performed without a steroid and can decrease sensitisation, therefore decreasing chronic pain. 
  • This method can be prolonged further than it is able to, whereas Occipital nerve block can be readministered and effective
• Pulsed radiofrequency
  • Used to target the painful nerve using a high-frequency current.
  • Might not always cure the pain and an increase in pain is common, whereas occipital nerve block can be performed again to numb the pain¹⁸
• Occipital nerve stimulation
  • Insertion of electrodes in the rear end of the spine
  • Fully reversible.
  • Complications such as migration, infection, muscle spasms and pain can occur, whereas occipital nerve block complications are rare
• Neurolysis of the Occipital Nerve
  • Degeneration of nerve endings which is proven to be safe and allows pain relief. 
  • Irreversible process
  • A study showed it provided f pain relief in 50%, whereas Occipital nerve block provided 95% satisfaction

Summary

In conclusion, an occipital nerve block is a procedure which involves a local anaesthetic and steroid. It is administered to the occipital nerve which is located at the back of the head and neck area. If these nerves become inflamed, they can cause severe pain and headaches which can affect an individual’s quality of life. Therefore, some patients may seek out various treatment methods to subside this pain. If first-line treatment does not work, second-line treatments can be an option, such as occipital nerve blocks. The procedure is very quick, and it is rare to have complications after the treatment unless you are from a high-risk group. It can last several months and if the problem persists it can be re-administered. This method can only be recommended if you have been physically examined by a doctor and if the nerve block does not provide any pain relief the first time, you must be re-examined in order to find the source of the pain. There are other methods to relieve these severe headaches, but occipital nerve block is proven to be the most effective form of treatment.