Greater Occipital Nerve Block


What is a Greater Occipital Nerve Block?

A  greater occipital nerve block is an injection of local anesthetic and steroid around the nerves which supply the scalp.  These nerves are located on the back of the head, and the top of the neck.


How does it work in migraine?

This procedure is predominately used for Cervicogenic headache.  Most primary headaches happen because there is abormal gain (amplification) of pain and other sensory messages in the trigeminal nucleus, in the brainstem.  The greater occipital nerve feeds upwards into the trigeminal nucleus. The nerve block reduces traffic in this nerve, so the abnormal gain in the trigemonal nucleus is diminished, therefore reducing the symptoms of migraine and other primary headaches.  One might guess that this treatment works for only pain at the back of the head: it can also work for pain at the front of the head, such as cluster headache.


The procedure

The injection itself only takes a few minutes or so.   The injection is just behind the ear and can be performed on one side (unilateral) or both sides (bilateral).   It can be done siting in a chair, or lying down.


Following the injection

The back of your head may feel a little numb.  This is perfectly normal.   Check that any bleeding has stopped before you leave the office.  If not, press gently with a tissue on the injection site.


What side effects might I get?

You may notice a lump at the injection site for a few or several days.  About one in 30 patients experience transient worsening of their head pain.   Very rarely, patients can faint with injections; these patients should be lying down to have injections.


How long will it be before I notice any benefit?

Improvement may be noticed shortly after injection or within a few days.


How many do I need to have?

The injection can be repeated after a month if symptoms are improved but are transient.   Other wise, it can be repeated as often as every two months. If the injections need to be repeated every two months for a year then it may be better to consider another treatment.

Not all treatments work the same every time; if you have two successive greater occipital nerve blocks with insufficient benefit, it’s probably best to try a different treatment.


Who cannot have a nerve block?

You cannot have this nerve block if you are allergic to any of the medications being injected or if you have an active infection near the injection site.

Please make the doctor aware of any other medical problems you have now or have had in the past before having the nerve block.



Trigger Point Injections

Trigger point injection (TPI) may be an option for treating pain in some patients.  TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax.  Many times, such knots can be felt under the skin.  Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.


The Procedure

In the TPI procedure, your provider inserts a small needle into the patient’s trigger point.  The injection contains a local anesthetic or saline, and may include a corticosteroid.  With the injection, the trigger point is made inactive and the pain is alleviated.  Usually, a brief course of treatment will result in sustained relief.  Injections usually take just a few minutes.  Several sites may be injected in one visit.