From the Guidelines
Occipital nerve block injection is suggested for the short-term treatment of migraine, with a "weak for" recommendation, as it has been shown to provide relief from migraine symptoms, although the overall quality of the evidence is deemed low 1.
Procedure Overview
The procedure involves injecting local anesthetic and sometimes corticosteroids around the greater and/or lesser occipital nerves to treat occipital neuralgia and certain headache disorders.
- The patient is typically seated or lying prone with their head flexed forward.
- The injection site is cleaned with antiseptic solution, and the physician palpates the occipital ridge to locate the nerve.
- A 25-27 gauge needle is used to inject a solution typically containing 2-3 mL of local anesthetic (such as 0.5% bupivacaine or 1-2% lidocaine) mixed with a corticosteroid (like methylprednisolone 20-40 mg or triamcinolone 10-40 mg).
Potential Benefits and Risks
- Patients may experience immediate relief from the anesthetic effect, which can last several hours, while the steroid component may provide longer-lasting relief over days to weeks by reducing inflammation around the nerve.
- Potential side effects include temporary numbness in the scalp, dizziness, and rarely, infection or bleeding at the injection site.
Clinical Considerations
- The procedure typically takes only a few minutes to perform and can be done in an outpatient setting with minimal recovery time.
- Clinicians should be aware of the potential benefits and risks of the procedure and discuss them with patients before making a decision.
- The evidence for the use of occipital nerve block for the prevention of chronic migraine is insufficient, and therefore, it is not recommended for this indication 1.
From the Research
Occipital Nerve Block Injection Procedure
The occipital nerve block injection procedure is a treatment method used for various headache disorders, including occipital neuralgia, migraines, and cervicogenic headache. The procedure involves injecting a local anesthetic and/or corticosteroid into the greater or lesser occipital nerve.
Indications and Effectiveness
- The procedure has been shown to be effective in reducing pain scores and frequency of headaches in patients with occipital neuralgia 2 and migraines 3.
- A study found that 95.45% of patients who underwent the occipital nerve block procedure showed satisfactory results for at least 6 months 2.
- However, a randomized, double-blinded, placebo-controlled study found that occipital nerve block did not reduce the frequency of moderate to severe migraine days compared to placebo 4.
Technique and Selection Criteria
- The technique of the procedure involves injecting a local anesthetic and/or corticosteroid into the greater or lesser occipital nerve 2, 3.
- Some practitioners use occipital nerve tenderness to palpation or reproduction of headache pain with occipital nerve pressure as selection criteria for identifying appropriate patients 5.
- However, current evidence suggests that these selection criteria are not necessary for cervicogenic headache or cluster headache 5.
Comparison of Local Anesthetics and Corticosteroids
- A study found that adding triamcinolone to local anesthetics did not increase the efficacy of greater occipital nerve block for transformed migraine 6.
- Another study found that there was no statistically significant difference in the effectiveness of occipital nerve block with regard to the local anesthetic used or the pain group targeted 2.