Alton patients are seen at the Headache Express clinic in St. Louis, Missouri. For headache that starts at the base of the skull, an image-guided occipital nerve block settles the diagnosis at the same visit, and the plan also covers cervicogenic headache and attacks tied to broken sleep.
From Alton the route is either the Clark Bridge and south through St. Charles County, or east to I-255 and down to I-270 west. Either way it ends at Woodson Road on the Missouri side, next to Lambert Airport.
Is pain at the base of the skull occipital neuralgia or migraine?
Pain that begins at the top of the neck and travels up over the back of the head, sometimes reaching behind the eye, is a distinct pattern with distinct treatment. It is frequently carried under a migraine label for years, and the two genuinely do overlap, but the features that separate them are checkable.
Sharp, shooting or electric-shock pain, strictly one-sided, with a tender spot at the base of the skull and sometimes an oddly sensitive scalp, points toward occipital neuralgia rather than migraine. The comparison is set out in occipital neuralgia or migraine.
How does an occipital nerve block diagnose headache pain?
Where the occipital nerves are suspected, anesthetizing one settles the question quickly. If numbing that nerve abolishes the pain, the nerve is carrying it. If it does not, the pain is arising elsewhere and the diagnosis moves on — which is a useful result rather than a wasted trip.
That second half only holds if the injectate reached the nerve, which is why the injection is imaged rather than placed by feel. See occipital nerve block and why image guidance matters.
Making one trip count
Where distance is a real constraint, it is worth using the visit to settle the diagnosis rather than only to treat the day’s pain. A guided block is informative either way, which is exactly what you want from a journey you would rather not repeat unnecessarily. What the appointment involves is described in what to expect.
What if an occipital nerve block doesn’t work?
A diagnostic block that fails to help is informative rather than wasted, but only if two things were true: it was image-guided, and it targeted the right nerve. If either is uncertain the result means nothing, and repeating it properly is reasonable rather than stubborn.
The greater and lesser occipital nerves run in different places and refer pain to different territory, and pain behind the ear treated at the midline is a common and entirely mechanical reason for a genuine non-response — see the anatomy.
There is also a smaller group in whom a block briefly makes things worse before settling, which is unnerving if nobody warned you it can happen. That question is answered directly, and so is what goes into the injection.
Why do headaches wake you up in the early morning?
Headaches that arrive out of sleep, or that are reliably present on waking, are worth treating as a sleep problem as well as a headache problem. The relationship runs both ways: poor or fragmented sleep lowers the threshold for attacks, and attacks fragment sleep further.
Untangling that is not a lifestyle lecture. It changes what we treat first, because a preventive plan built while someone is sleeping four broken hours a night is being asked to work against a driver nobody addressed. Sleep and migraine covers the mechanism and what is actually worth changing.
What is the difference between occipital neuralgia and cervicogenic headache?
Two neighboring diagnoses get confused constantly. Occipital neuralgia is a nerve problem — sharp, shooting, along the nerve’s course, often with a tender point where it exits. Cervicogenic headache is a joint problem in the upper neck referring pain upward, usually duller, side-locked, and provoked by neck position rather than by touch.
They coexist often enough that the useful question is which is dominant, and that is answered by targeted blocks rather than by argument. Cervicogenic headache and occipital neuralgia cover the treatments, which diverge once the source is settled.
What to track before you come
Two weeks of a simple record is worth more than any description from memory. Date, time it started, how long it lasted, which side, what you took and whether it worked. Nothing elaborate.
The reason is that headache patterns are almost impossible to recall accurately — people reliably undercount frequency and overestimate how well an acute drug is working. A record turns a vague history into a countable one, and the count is what decides which treatments you qualify for.
Bring the whole medication list
Including what you take occasionally, what you buy without a prescription, and what you stopped. Combination analgesics and anything containing caffeine matter disproportionately here, and people leave them out because they do not think of them as medication.
Supplements count too, and not because we disapprove of them. Some interact, some are at doses with actual evidence behind them, and knowing what is already in place keeps us from duplicating something that is working.
How soon you can be seen
Alton is close enough that a same-week appointment is usually workable, and an attack that has been running for days is treated as urgent rather than slotted in. Say on the phone that it is unremitting; that changes the appointment type.
For a diagnostic visit there is no advantage to rushing, and a slot when you are not mid-attack is frequently more useful — examination findings are easier to interpret between attacks than during one.
Further along the river, headache treatment for Edwardsville covers the Botox question for chronic migraine, and the Illinois page covers licensing and Anderson Hospital.
Common questions
How long does the relief last?
The anesthetic wears off in hours but the benefit often lasts weeks, and duration varies widely between people. See how long a block lasts.
Will I be able to drive back across the bridge?
Yes. There is no sedation and you drive yourself home. Numbness at the back of the head is expected and wears off over several hours — see side effects and risks.
I had a block elsewhere and it did nothing.
Worth establishing two things: whether it was image-guided, and which nerve was targeted. Pain behind the ear treated at the midline is an ordinary reason for a genuine non-response — see the anatomy.
Can an occipital nerve block make headaches worse?
Briefly, in a smaller group of people. The block can make things worse for a short time before the pain settles. That is unnerving if nobody warned you, which is why we tell you beforehand. Numbness at the back of the head is also expected afterward and wears off over several hours; it is not a complication.
Can you have an occipital nerve block more than once?
Yes, when there is a reason. A block that failed to help only tells us something if it was image-guided and aimed at the right nerve. If either is uncertain, the result means nothing and repeating it properly is reasonable. Pain behind the ear treated at the midline is a common, mechanical reason a first block did not work.
Why is an occipital nerve block done with imaging?
Because a negative result only counts if the injection reached the nerve. Imaging confirms placement, so when numbing the nerve does not stop the pain, the diagnosis can move on with confidence instead of wondering whether the needle missed. The greater and lesser occipital nerves run in different places, and imaging keeps the block on the one that matches your pain.