Occipital neuralgia treatment starts with an occipital nerve block. That is local anesthetic placed around the nerve at the base of the skull. If the pain goes, that nerve was the source. Relief commonly outlasts the anesthetic by weeks.
Sharp, electric pain running from the base of the skull up the back of the head — and one of the few headaches with a treatment that also confirms the diagnosis.
What are the symptoms of occipital neuralgia?
Paroxysms (bursts) of stabbing or shock-like pain along the greater or lesser occipital nerve. The pain runs from the top of the neck, over the back of the head, and sometimes as far as behind the eye on the same side. Between the jolts there is often a steady ache.
Two features are close to characteristic. The scalp over the affected nerve is tender enough that brushing your hair, wearing a hat or lying on a pillow hurts. And pressing on the nerve where it emerges below the base of the skull reproduces the pain.
How does an occipital nerve block treat occipital neuralgia?
An occipital nerve block places local anesthetic directly around the nerve. If the pain goes, that nerve was the source — which both treats the episode and settles the diagnosis. If it does not go, the pain is coming from somewhere else. Then the diagnosis needs to move, most often toward cervicogenic headache or migraine.
Relief commonly outlasts the anesthetic by weeks. How the next block is timed depends on how long the last one held and on what is happening clinically — not on a fixed series.
Why is occipital neuralgia mistaken for migraine?
It gets called migraine because it is one-sided and can radiate behind the eye. It gets called a pulled muscle because it follows neck movement. The scalp tenderness is the feature that most reliably points the right way. And it is rarely asked about.
Booking online shows our scheduled openings; call or text for hours that are not listed. Please contact us before coming in rather than arriving unannounced — we need to know what is happening to have the right treatment ready.
A note on coverage, and on timing. Same-day treatment and prior authorization do not run on the same clock. Many insurers take days to weeks to decide, and some acute headache treatments are not covered at all. Your headache will not wait for that process.
We will verify your benefits and, where a treatment needs prior authorization, we will attempt to obtain it. An authorization confirms that a service meets criteria for review — it is not a guarantee of payment, and no clinic can make that promise on your insurer’s behalf. Where something is unlikely to be covered, or cannot be certified in time to treat you today, we will tell you before we treat rather than after, so the decision is yours. Payment is due at the time of service.
Frequently asked questions
How is occipital neuralgia diagnosed?
Two findings point to it. One is a scalp so tender that brushing your hair, wearing a hat or lying on a pillow hurts. The other is pain reproduced by pressing on the nerve just below the base of the skull. An occipital nerve block then settles it. If numbing the nerve takes the pain away, that nerve was the source.
How long does an occipital nerve block last?
Relief commonly outlasts the local anesthetic by weeks. When the next block is given depends on how long the last one held and on what is happening clinically, not on a fixed series of injections. Each block is timed to your response rather than booked in advance.
What if the occipital nerve block does not help?
Then the pain is coming from somewhere else, and the block has still done its job as a test. The diagnosis moves. Most often it moves toward cervicogenic headache, where pain is referred from the neck, or toward migraine. Each of those has its own treatment. So a block that fails narrows the search instead of ending it.