Occipital Nerve Block

Performed by Top Pain Management Doctors in San Antonio, Texas


Occipital Nerve Block performed by top doctors in Tyler, Longview, Lufkin & Sulphur, TexasNerve blocks are special injections used to diagnose and treat neck pain. Most pain specialists agree that nerve blocks can dramatically improve pain increase quality of life. Occipital Nerve blocks involve injection of local anesthetic and corticosteroid into the occipital nerves, which are often implicated in cephalgia and cervicalgia, or head and neck pain. The occipital nerves are located at the back of the head, or the occiput.

One painful condition of the head and neck treated with occipital nerve blockade is occipital neuralgia, which arises from trauma, irritation or compression of the occipital nerves (Güvençer et al, 2011; Vanelderen et al, 2010). Symptoms of occipital neuralgia may include paroxysmal stabbing headache, tinnitus, tingling of the scalp, nausea, dizziness and visual disturbances. Occipital nerve blocks can produce significant relief of headaches caused by occipital neuralgia and can aid in the diagnosis of the disorder (Kuhn et al, 1997).

Primary headache disorders such as migraine, cluster and cervicogenic headaches may also be treated with an occipital nerve block (Levin, 2010; Tobin & Flitman, 2009; Young, 2010), bringing relief to patients with persistent headaches (Paemeleire & Bartsch, 2010).

Migraines, a chronic neurological disorder, are marked by extremely painful headaches, visual disturbances and nausea. Occipital nerve blockade has been shown in clinical studies to alleviate the pain of migraines and possibly migraine auras, which are associated with irreversible neurologic deficits (Rozen, 2007). Another benefit of occipital nerve blocks in the suppression of migraines is that nerve blocks may represent a viable alternative to orally administered medications (Weibelt et al, 2010).

Cluster headaches, considered the most severe of the primary headache syndromes (Ashkenazi & Schwedt, 2011), are characterized as short-lived, excruciating, one-sided (unilateral) pain that often presents around the eye. Research suggests that occipital nerve blockade may be effective in controlling the intensity, frequency and duration of cluster headaches (Afridi et al, 2006; Peres et al, 2002; Scattoni et al, 2006), and may be an important treatment alternative in patients unable to use oxygen and the drug sumatriptan due to side-effects or contraindications to these therapies (Scattoni et al, 2006).

Cervicogenic headaches originate from disorders of the neck and anatomical structures innervated by the nerve roots extending from the neck region of the spine (Gabrhelík et al, 2011). In patients with cervicocranial pain syndromes, occipital nerve blockade has been known to arrest pain more quickly than, and reduce intake of, orally administered drugs, thereby preventing side effects and improving quality of life (Gabrhelík et al, 2011; Medvedeva, 2008; Medvedeva et al, 2008). For example, a randomized, double-blind, placebo-controlled trial in 50 adult patients with cervicogenic headache found occipital nerve blockade was effective in reducing pain scales by approximately 50% from baseline values (Naja et al, 2006). Furthermore, analgesic consumption; duration and frequency of headaches; nausea; vomiting; sensitivity to light and sound; decreased appetite; and limitations in functional activities were reduced significantly in these patients for as long as two weeks following injection.

Occipital nerve blocks may also be effective in patients with hemicrania continua headache disorder who present with tenderness in the occipital nerve area. A study of patients with hemicrania continua reported total or partial improvement in the nine patients with hemicrania continua who received nerve blocks. The patients received at least one anesthetic block of the greater occipital nerve or supraorbital nerve, an injection of corticosteroids in the trochlear area or were treated with a combination procedure. Reduction in symptoms lasted two to 10 months.

Anatomy

Sensation at the rear portion of the scalp is provided by cervical nerves that branch from spinal cord levels C2 and C3. Among these branches are the greater, lesser and third occipital nerves. The greater occipital nerve, which arises from C2, innervates a large portion of the posterior (back) area of the scalp. The lesser occipital nerve, which is also a part of the cervical plexus, supplies an area of the scalp superior (above) and posterior to the ear. The third occipital nerve supplies a small area of the lower part of the posterior scalp.

Procedure

Occipital nerve blockade involves insertion of a small fine needle into the scalp at the rear of the head in order to deliver anesthetic and corticosteroid medications to affected nerve tissue. A successful block is characterized by immediate and dramatic pain relief. If symptoms improve following the injection, the occipital nerves are implicated as the source of a patient’s pain. If pain relief occurs with an occipital nerve block, future injections or more permanent pain relief options such as radiofrequency ablation or occipital nerve stimulation may be offered.

Benefits

Occipital nerve blockade has a long and proven track record of efficacy in the treatment of head and neck pain. A chart review found that 100 percent of patients with occipital neuralgia who received an occipital nerve block of lidocaine and dexamethasone experienced at least 50 percent reduction of original pain (Jürgens et al, 2012).

Occipital nerve block has also been used in several primary headache syndromes with good results. Researchers performed unilateral or bilateral occipital nerve blocks consecutively on 150 consecutive patients presenting with cervicogenic chronic migraine (CCM) (Weibelt et al, 2010). A positive treatment outcome was defined as a 50 percent or greater reduction in headache days per month over the 30 days following treatment relative to the 30-day pre-treatment baseline. At the one-month follow-up visit, 78 (52%) exhibited evidence of a positive treatment response according to the primary outcome variable, and 90 (60%) reported their headache disorder to be “better” (44; 29%) or “much better” (46; 30%). A total of eight (5%) patients reported adverse events within the ensuing 72 hours, and three (2%) experienced adverse events that reversed spontaneously but required emergent evaluation and management.

Occipital nerve block injections are considered quite safe when performed by an experienced practitioner. However, every medical procedure is associated with risks and possible complications. A minority of patients have experienced minor tenderness at the injection site, bleeding, tissue damage and infection after receiving an occipital nerve block. Patients taking blood thinners or with active infection may need to postpone the procedure. Experiencing an adverse reaction to the anesthetic or corticosteroid used is another risk, although it is rare (Sahai-Srivastava & Subhani, 2010).

Another risk of occipital nerve block is failure to respond to the treatment. For example, patients with occipital neuralgia or migraine who overuse symptomatic medication may not achieve pain relief from occipital nerve blockade (Tobin & Flitman, 2009). In addition, there may be inconsistency in nerve location between individuals. A cadaver study found significant variation in the pathway of the greater occipital and lesser occipital nerves (Becser et al, 1998). The researchers concluded optimal locations for blockade techniques should be reconsidered. Fortunately, a more recent study defined the average physical limits of these nerves to help practitioners avoid complications (Güvençer et al, 2011).

Few serious sequelae for occipital nerve block have been noted in the medical literature, and the procedure is generally considered to have a low rate of complications (Akin Takmaz et al, 2010).

Outcomes

Positive outcomes in occipital nerve block are typically defined as pain relief of 50 percent or greater, as well as patient satisfaction with the procedure. Once pain relief from an occipital nerve block is confirmed in an individual, he or she may receive future therapeutic blocks to maintain results. Alternatively, he or she may be eligible for more permanent pain relief through procedures such as radiofrequency ablation, neurolysis or implantation of an occipital nerve stimulator to attain more prolonged pain relief.

Patients with head and neck pain should consult with a board-certified, experienced pain management specialist. Such an individual is qualified to diagnose painful conditions and suggest appropriate treatment options.

Journal Articles/Resources

  1. Occipital Nerve Block – Paindoctor.com
  2. Afridi SK, Shields KG, Bhola R, & Goadsby PJ. (2006). Greater occipital nerve injection in primary headache syndromes–prolonged effects from a single injection. Pain.122(1-2):126-9.
  3.  Akin Takmaz S, Unal Kantekin C, Kaymak C, & Başar H. (2010). Treatment of post-dural puncture headache with bilateral greater occipital nerve block. Headache. 50(5):869-72.
  4.  Ashkenazi A, & Schwedt T. (2011). Cluster headache–acute and prophylactic therapy. Headache. 51(2):272-86. doi: 10.1111/j.1526-4610.2010.01830.x.
  5.  Becser N, Bovim G, & Sjaastad O. (1998). Extracranial nerves in the posterior part of the head. Anatomic variations and their possible clinical significance. Spine (Phila Pa 1976). 23(13):1435-41.
  6.  Gabrhelík T, Michálek P, & Adamus M. (2011). Pulsed radiofrequency therapy versus greater occipital nerve block in the management of refractory cervicogenic headache – a pilot study. Prague Med Rep. 112(4):279-87.
  7.  Güvençer M, Akyer P, Sayhan S, & Tetik S. (2011). The importance of the greater occipital nerve in the occipital and the suboccipital region for nerve blockade and surgical approaches–an anatomic study on cadavers. Clin Neurol Neurosurg. 2113(4):289-94.
  8. Jürgens TP, Müller P, Seedorf H, Regelsberger J, & May A. (2012). Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain.
  9. J Headache Pain. 13(3):199-213.
  10. Kuhn WF, Kuhn SC, & Gilberstadt H. (1997). Occipital neuralgias: clinical recognition of a complicated headache. A case series and literature review. J Orofac Pain. 11(2):158-65.
  11.  Levin M. (2010). Nerve blocks in the treatment of headache. Neurotherapeutics. 7(2):197-203.
  12. Medvedeva LA. (2008). [Cervicogenic headaches: aspects of diagnosis and analgesia]. [Article in Russian]. Anesteziol Reanimatol. (5):96-9.
  13.  Medvedeva LA, Zagorul’ko OI, Gnezdilov AV, & Syrovegin AV. (2008). [Use of anesthesiological technologies in the complex treatment of cervicocranial pain syndromes].[Article in Russian]. Anesteziol Reanimatol. (5):92-6.
  14.  Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, & Tawfik OM. (2006). Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Pract. 6(2):89-95.
  15. Paemeleire K, & Bartsch T. (2010). Occipital nerve stimulation for headache disorders. Neurotherapeutics. 7(2):213-9.
  16.  Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, & Silberstein SD. (2002). Greater occipital nerve blockade for cluster headache. Cephalalgia. 22(7):520-2.
  17.  Rozen T. (2007). Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache. 47(6):917-9.
  18.  Sahai-Srivastava S, & Subhani D. (2010). Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia. J Headache Pain. 11(6):519-23.
  19.  Scattoni L, Di Stani F, Villani V, Dugoni D, Mostardini C, Reale C, & Cerbo R. (2006). Great occipital nerve blockade for cluster headache in the emergency department: case report. J Headache Pain. 7(2):98-100.
  20. Tobin J, & Flitman S. (2009). Occipital nerve blocks: when and what to inject? Headache. 49(10):1521-33.
  21.  Vanelderen P, Lataster A, Levy R, Mekhail N, van Kleef M, & Van Zundert J. (2010). Occipital neuralgia. Pain Pract. 10(2):137-44.
  22. Weibelt S, Andress-Rothrock D, King W, & Rothrock J. (2010). Suboccipital nerve blocks for suppression of chronic migraine: safety, efficacy, and predictors of outcome. Headache. 50(6):1041-4.
  23.  Young WB. (2010). Blocking the greater occipital nerve: utility in headache management. Curr Pain Headache Rep. 14(5):404-8.