From the Research
An occipital nerve block with ketorolac involves injecting medication around the greater and/or lesser occipital nerves to treat headaches and occipital neuralgia, with the most recent and highest quality study suggesting the use of bilateral bi-level greater occipital nerve blocks (GONB) for optimal results 1. For this procedure, prepare ketorolac 30mg combined with a local anesthetic such as 3-5ml of 0.5% bupivacaine or 1-2% lidocaine in a 5-10ml syringe with a 25-27 gauge needle. Position the patient sitting with their head flexed forward. Identify the occipital protuberance and mastoid process, then locate the greater occipital nerve approximately one-third of the distance from the occipital protuberance to the mastoid process, about 2-3cm lateral to the midline. After cleaning the area with antiseptic solution, insert the needle perpendicular to the skin until contact with the periosteum, then withdraw slightly. Aspirate to ensure you're not in a blood vessel, then inject 2-3ml of the solution. For bilateral headaches, repeat on the opposite side. The ketorolac provides anti-inflammatory effects while the local anesthetic offers immediate pain relief. Some key points to consider when performing an occipital nerve block include:
- The use of bilateral bi-level GONB has been shown to be superior to single level blocks and intramuscular injection, with a low recurrence rate and significant improvement in patients' quality of life 1.
- The procedure can be used to treat a variety of headache disorders, including migraines, cluster headaches, and occipital neuralgia 2, 3.
- The choice of local anesthetic and dosage may vary depending on the specific patient and condition being treated, with some studies suggesting the use of lidocaine or bupivacaine 4, 5. Patients should be monitored for 15-30 minutes after the procedure for any adverse reactions, and informed that pain relief may last from several hours to weeks depending on their condition. It is also important to note that the procedure may not be effective for all patients, and that further studies are needed to fully understand the efficacy and safety of occipital nerve blocks for the treatment of headaches and occipital neuralgia 2, 4.