A small injection at the base of the skull, done sitting up, with no sedation. The needle part takes seconds. Most of the appointment is the conversation before it.
Before
We establish what we are treating and why, because the block is often diagnostic as well as therapeutic. Tell us where the pain starts, whether your scalp is tender to a hairbrush or a pillow, and whether neck position changes anything — those answers determine the target.
Bring your medication list. You do not need to fast, you do not need a driver, and you can eat normally beforehand.
During
You sit leaning slightly forward. The landmarks are identified, the skin is cleaned, and we place the injection under ultrasound guidance — the occipital artery runs alongside the nerve, and ultrasound shows both so the needle can be steered around the vessel.
A small volume of local anesthetic goes in, sometimes with a corticosteroid depending on what we are treating. The needle is fine. Most people describe pressure and a brief sting.
After
- Numbness over the back of the head on the treated side. Expected, and it wears off over several hours.
- A heavy or odd-feeling scalp for the rest of the day.
- Occasional light-headedness for a few minutes — we will have you sit before you stand.
- Tenderness at the injection site for a day or two.
You walk out and drive yourself home. There is no recovery period and no sedation to sleep off. Most people go back to work.
What counts as a result
Two things happen on different timescales, and they mean different things.
The immediate effect — within minutes, while the anesthetic is working — is the diagnostic part. If the pain goes, that nerve was carrying it. If it does not, the pain is arising elsewhere and the diagnosis moves. See do nerve blocks for headache actually work.
The durable effect is the therapeutic part. Relief frequently outlasts the anesthetic by weeks — longer than the pharmacology alone explains, probably because interrupting the pain signal lets an irritated nerve settle. Duration varies widely between people.
How often
There is no fixed series of three. That number is a convention, not a clinical finding. We time the next block by how long the last one held and by what is happening clinically.
If a block gives four months of relief, we repeat it at four months. If it gives four days, repeating it is not the answer and we look again at the diagnosis.
What it treats
The strongest fit is occipital neuralgia and cervicogenic headache. It is also used as a transitional treatment during a cluster bout, where a meta-analysis found 50% of patients pain-free at one month.1 In migraine the evidence is more mixed and the clearest indication is where there is a cervical or occipital contribution.
Common questions
Do I need someone to drive me?
No. There is no sedation, and you drive yourself home. See occipital nerve block.
Is the numbness afterwards normal?
Yes — numbness over the back of the head on the treated side is the expected result of anesthetizing that nerve, and it wears off over several hours. See occipital nerve block.
What if it wears off after a few days?
That is useful information. A short-lived response suggests the nerve is involved but is not the whole story, and we look at the upper cervical joints — see is your headache coming from your neck.
Can I have it during pregnancy?
It is sometimes appropriate, and the calculation differs from most headache drugs because the exposure is local and small. Tell us and we will discuss it — contact us.
Being seen at Headache Express. We treat migraine, cluster and other severe headaches in St. Louis, usually the same day. Please contact us before coming in so the right treatment is ready when you arrive.
Sources
- Zhang H, et al. Efficacy and safety of greater occipital nerve block for the treatment of cluster headache: a systematic review and meta-analysis. 2020. PMID 32781922. pubmed.ncbi.nlm.nih.gov