An occipital nerve block is a small injection of local anesthetic around one of the nerves at the base of the skull. It takes seconds and needs no sedation. It is used both to treat headache and to work out where the pain is actually coming from.
What does an occipital nerve block treat?
- Occipital neuralgia — the clearest indication. Sharp, shooting or electric pain in the territory of the nerve, often with a tender spot over it.
- Cervicogenic headache — headache arising from the structures of the upper neck.
- Cluster headache, as a transitional treatment while a preventive is taking effect. A meta-analysis of greater occipital nerve block in cluster headache found a pooled proportion of pain-free patients at one month of 50%. That is the share of patients free of pain, pooled across the studies.
- Migraine, most clearly where there is a cervical or occipital contribution — neck-triggered attacks, scalp tenderness, pain running from the base of the skull.
What the evidence shows, and what it does not
Meta-analyses of randomized trials in migraine consistently find that occipital nerve block reduces pain intensity, the number of headache days, and how much acute medication people need.1,2 The largest single randomized, multicenter, double-blind, placebo-controlled trial in chronic migraine used weekly bupivacaine blocks for a month. Headache days fell from 18.1 a month to 8.8 after the blocks, against 16.9 to 13.2 on saline.3
The same analyses are equally clear about what it does not do. It does not shorten the duration of an individual headache.1,2 This treatment reduces how often and how badly you get headaches. It is not primarily a way to end the attack you are having today — for that, see IV migraine therapy.
A 2024 meta-analysis in chronic migraine reached similar conclusions. It also added the appropriate caution. The number of trials is small and the samples modest, so these are encouraging findings rather than settled ones.4
It is diagnostic as well as therapeutic
This is the part that is most often overlooked. It is why the procedure earns its place even when it does not relieve the pain. If numbing a specific nerve abolishes your headache, that nerve is carrying it. If it does not, the pain is arising somewhere else and the diagnosis moves on.
A negative result is only informative if the injectate (the injected medicine) actually reached the nerve. That is the entire argument for imaging. A failed landmark block tells you nothing at all. See why image guidance matters.
Which nerve, and why it matters
There is more than one. The greater occipital nerve supplies the back of the head, from near the midline up toward the crown. The lesser occipital nerve supplies the area behind and above the ear. The third occipital nerve covers a small area low at the back. It also serves the C2-C3 facet joint. Here is an ordinary reason for a block to do nothing: pain behind the ear treated with a midline greater occipital injection.
The full map, and why a nerve at the back of the head can produce pain felt behind the eye, is in greater and lesser occipital nerve anatomy.
What is injected in an occipital nerve block?
Local anesthetic — lidocaine, bupivacaine, or both. A corticosteroid is sometimes added. But the evidence that it improves outcomes in migraine is weaker than most people assume. In a four-arm randomized trial, the groups whose injection contained anesthetic, rather than the steroid group, were the ones that reduced headache frequency.5 See steroid or anesthetic.
How is an occipital nerve block done?
You sit leaning slightly forward. The skin is cleaned and the injection is placed under ultrasound. The occipital artery runs alongside the nerve. Ultrasound shows both, with Doppler to confirm which is which. It also shows the needle as it advances — see ultrasound and fluoroscopic guidance.
It takes seconds. There is no sedation and you drive yourself home. Numbness over the back of the head on that side is the expected result. It wears off over several hours. A step-by-step account of the appointment is in what to expect from an occipital nerve block.
How long does an occipital nerve block last, and how often can you have one?
The anesthetic wears off within hours. The benefit frequently outlasts it by weeks, which is more than the pharmacology (how the drug acts) alone explains. Duration varies widely and is not predictable in advance. There is no fixed course — the next block is timed by how long the last one held and by clinical need. See how long an occipital nerve block lasts.
What are the risks of an occipital nerve block?
Across randomized trials, adverse events have not differed significantly from placebo injections.1,4 The considerations that do matter are the occipital artery and aseptic (germ-free) technique. The artery is why the injection is imaged. Expected effects, the rare serious ones, and what should prompt a call afterward are set out in side effects and risks. A headache in the day or two after the injection is common and usually settles — see can a block make headaches worse.
Common questions
Does an occipital nerve block hurt?
It takes seconds and is a superficial injection. Most people describe pressure rather than pain. There is no sedation and you drive yourself home — see what to expect.
How quickly will I know if it worked?
The anesthetic acts within minutes. That answers the diagnostic question almost immediately. Whether it helps durably is judged over the following two to three weeks — see how long it lasts.
What if it does not work?
Provided it was image-guided, that is useful information rather than a wasted appointment. The pain is arising somewhere other than the nerve we blocked, and the diagnosis moves. It is also worth checking whether the right nerve was targeted — see the anatomy.
Can I have it while I am on other headache treatments?
Usually yes. It is commonly used alongside preventive treatment rather than instead of it — see Botox for chronic migraine and headache prevention.
What should I expect after an occipital nerve block?
Numbness over the back of the head on the injected side is the expected result. It wears off over several hours. There is no sedation, so you drive yourself home. A headache in the day or two after the injection is common and usually settles. The benefit often outlasts the anesthetic by weeks. Whether it helps durably is judged over the next two to three weeks.
Will an occipital nerve block stop the headache I have today?
That is not its main job. It reduces how often and how badly headaches come. But it does not shorten an individual headache. The anesthetic acts within minutes, which answers the diagnostic question quickly. To end an attack that is happening now, IV migraine therapy is the treatment built for that.
Does an occipital nerve block help cluster headache?
Yes, as a transitional treatment while a preventive is taking effect. A meta-analysis of greater occipital nerve block in cluster headache found a pooled proportion of pain-free patients at one month of 50%. It works alongside your cluster treatment rather than replacing it. Like every block here, it is placed under ultrasound guidance.
Do I need a referral?
No. You can contact us directly.
Sources
- Zhang H, Yang X, Lin Y, Chen L, Ye H. The efficacy of greater occipital nerve block for the treatment of migraine: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;165:129-133. doi:10.1016/j.clineuro.2017.12.026
- Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: a systematic review and meta-analysis. Am J Emerg Med. 2017;35(11):1750-1754. doi:10.1016/j.ajem.2017.08.027
- Inan LE, Inan N, Karadaş Ö, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand. 2015;132(4):270-277. doi:10.1111/ane.12393
- Mustafa MS, Bin Amin S, Kumar A, et al. Assessing the effectiveness of greater occipital nerve block in chronic migraine: a systematic review and meta-analysis. BMC Neurol. 2024;24(1):330. doi:10.1186/s12883-024-03834-6
- Malekian N, Bastani PB, Oveisgharan S, Nabaei G, Abdi S. Preventive effect of greater occipital nerve block on patients with episodic migraine: a randomized double-blind placebo-controlled clinical trial. Cephalalgia. 2022;42(6):481-489. doi:10.1177/03331024211058182
If the pain starts at the base of the skull and climbs over the scalp, an occipital nerve block is the quickest way to learn whether that nerve is the driver. It is one of the procedures behind our same-day headache treatment in St. Louis, alongside occipital neuralgia care.
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.