Can occipital nerve blocks alleviate cephalalgia (headaches)?

From the Guidelines

Occipital nerve blocks can be suggested for the short-term treatment of migraine, as indicated by the 2024 clinical practice guideline for the management of headache 1. The procedure involves injecting a local anesthetic around the greater and/or lesser occipital nerves, which can provide relief from headache symptoms.

• The guideline suggests greater occipital nerve block for the short-term treatment of migraine, although the evidence is considered weak 1.
• There is insufficient evidence to recommend for or against greater occipital nerve block for the prevention of chronic migraine 1.
• The effectiveness of occipital nerve blocks for other types of headaches, such as cluster headaches, is not well established, with insufficient evidence to recommend for or against their use 1.
• The decision to use occipital nerve blocks should be made on a case-by-case basis, taking into account the individual patient's symptoms and medical history, as well as the potential benefits and risks of the procedure 1. Key points to consider when using occipital nerve blocks for headache treatment include:
• The potential for temporary relief from headache symptoms
• The minimal side effects associated with the procedure, such as temporary soreness at the injection site, dizziness, or numbness
• The need for repeated injections to maintain relief, as the effects of the block are typically temporary
• The importance of using occipital nerve blocks as part of a comprehensive headache management plan, which may include other treatments such as medication, lifestyle changes, and alternative therapies 1.

From the Research

Effectiveness of Occipital Nerve Blocks for Headaches

• Occipital nerve blocks (ONBs) have been found to be an effective treatment for various types of headaches, including cervicogenic headache, cluster headache, and occipital neuralgia 2.
• ONBs may also be effective for migraine, with some studies reporting favorable results, although more research is needed to confirm this 2, 3.
• The procedure involves injecting a local anesthetic and possibly a corticosteroid near the occipital nerves at the base of the skull, aiming to provide relief from chronic headaches by temporarily numbing or reducing inflammation around the occipital nerves 3.

Types of Headaches Treated with Occipital Nerve Blocks

• Cervicogenic headache: ONBs have been found to be an effective treatment for this type of headache 2.
• Cluster headache: ONBs may be effective for cluster headaches, with some studies reporting favorable results 2, 3.
• Occipital neuralgia: ONBs are a common treatment for occipital neuralgia, which causes chronic, sharp, stabbing pain in the upper neck, back of the head, and behind the ears 4.
• Migraine: ONBs may be effective for migraine, although more research is needed to confirm this 2, 3, 5.

Safety and Adverse Effects of Occipital Nerve Blocks

• ONBs are generally well-tolerated, with minimal side effects associated mainly with the injection process, including numbness, tingling, and local discomfort 3, 6.
• Adverse effects are rare, but may include allergic reactions to the local anesthetic or corticosteroid, or nerve damage 6.
• Caution should be exerted when using 5% Lidocaine, especially in elderly patients, 70 or older, especially when administering bilateral injections 6.

Techniques and Selection Criteria for Occipital Nerve Blocks

• The technique of repetitive ONBs deserves further study 2.
• Some practitioners use occipital nerve tenderness to palpation or reproduction of headache pain with occipital nerve pressure as selection criteria for identifying appropriate patients, although the effectiveness of these criteria is unclear 2.
• The use of local anesthetics with steroids versus local anesthetics alone for ONBs is still a topic of debate, with some studies reporting favorable results with steroids, while others report no difference or even worse results 2, 5.