From the Guidelines
An occipital nerve block is indicated for patients experiencing unilateral or bilateral pain in the back of the head, tenderness over the greater or lesser occipital nerves, and associated symptoms such as light sensitivity, scalp hypersensitivity, and pain behind the eyes, as these symptoms suggest pain originating from the occipital nerves 1. The primary symptoms that suggest this procedure might be beneficial include:
- Unilateral or bilateral pain in the back of the head that radiates from the base of the skull forward
- Shooting, stabbing, or electric-like pain
- Tenderness over the greater or lesser occipital nerves
- Pain when brushing or washing hair
- Discomfort when lying on the back of the head Associated symptoms may include:
- Light sensitivity
- Scalp hypersensitivity
- Pain behind the eyes Specific conditions that might respond to occipital nerve blocks include:
- Occipital neuralgia, which presents with paroxysmal shooting or stabbing pain along the distribution of the greater, lesser, or third occipital nerves
- Cervicogenic headaches
- Cluster headaches
- Migraine headaches, particularly those with occipital tenderness
- Tension headaches
- Post-traumatic headaches The procedure works by delivering local anesthetic, sometimes combined with corticosteroids, to block pain signals from the occipital nerves to the brain, providing diagnostic information and therapeutic relief 1. Patients who have failed conservative treatments like oral medications, physical therapy, or lifestyle modifications are particularly good candidates for this minimally invasive procedure. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache, greater occipital nerve block is suggested for the short-term treatment of migraine, with a "weak for" recommendation 1.
From the Research
Symptoms Indicating an Occipital Nerve Block
The symptoms that would indicate an occipital nerve block include:
- Chronic, sharp, stabbing pain in the upper neck, back of the head, and behind the ears that can radiate to the front of the head 2
- Intermittent, painful episodes associated with the occipital region and the nerves described above 2
- Unilateral pain, however bilateral pain can be present and the pain can radiate to the frontal region and face 2
- Tenderness over the greater occipital and lesser occipital nerves 2
- Headache syndromes often involve occipital and neck symptoms suggesting a functional connectivity between nociceptive trigeminal and cervical afferents 3
- Photophobia and phonofobia severity 3
Headache Conditions
Occipital nerve blocks can be utilized alone or with standard-of-care therapy for various other headache conditions, such as: