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Occipital Nerve Block

What is an occipital nerve block?

An occipital nerve block is an injection of a steroid or other medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area.

What is the purpose of an occipital nerve block?

The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the nerves and surrounding structures. Typically, headaches over the back of the head, including certain types of tension headaches and migraine headaches, may respond to occipital nerve blocks.

How long does the occipital nerve block take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic and a steroid medication.

Will the occipital nerve block hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle during the performance of the block.

Will I be “put out” for the occipital nerve block?

No. This procedure is done with a small thin needle, usually without any sedation. There is local anesthetic within the injection.

How is the occipital nerve block performed?

It is done with the patient seated or lying down. The skin and hair of the back of the head are cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the occipital nerve block?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have a sore head for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing a more lasting pain relief starting the third day or so.
What should I do after the occipital nerve block?

You will rest for a while in the office. Most patients can drive themselves home. We advise the patient to take it easy for several hours after the procedure. You may want to apply ice to the injected area. You can perform any activity you can tolerate.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is a sore head at the injection site.

How long does the effect of the medication last?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about 3 to 5 days and its effect can last for several days to a few months.

How many occipital nerve blocks do I need to have?

It varies. The injections are done about one week apart only if needed. If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have a second injection. If you respond to the injections, you may be recommended for additional injections when the symptoms return.

Can I have as many occipital nerve blocks as I need?

With some exceptions, in any given six-month period, we generally do not like to perform more than three occipital nerve blocks. This is because giving more injections could increase the likelihood of side effects from the steroids that are injected. Likewise, if the patient needs more frequent injections, other treatments should probably be considered.

Will the occipital nerve blocks help me?

It is difficult to predict if the injection will help you or not. Generally speaking, patients who have recent onset of pain may respond much better than the ones with a longstanding pain. Usually the first injection is as much a test as a treatment. The first block will confirm that the occipital nerves are involved in the pain and be helpful. Or it will not help and the occipital nerves will not be suspected as part of the pain.

What are the risks and side effects of occipital nerve blocks?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Other uncommon risks involve infection, bleeding, worsening of symptoms etc. Fortunately, serious side effects and complications are uncommon.

Who should not have an occipital nerve block?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have an occipital nerve block or at least consider postponing it if postponing would improve your overall medical condition.

Adapted: http://www.medcentral.org/body.cfm?id=351, July 25th, 2010.