What are occipital nerve blocks?
An occipital block is an outpatient injection performed on either side of the head around the areas of the occipital nerves for pain relief. These are peripheral nerves supplying sensation to the base of the head moving up to the top of the head bilaterally.
What do they work well for?
Occipital nerve blocks have been studied in many research studies, and actually need a lot more research in some conditions to establish efficacy or not. One reason is a lot of these studies did not utilize a control, but just did a bunch and looked back at the results retrospectively.
It has been shown to work well for cluster headaches, cervicogenic headaches, and occipital neuralgia. Additionally, it has shown good results for patients who overuse narcotic medication and have headaches and possibly those in the withdrawal phases to make the headache pain less.
There are also multiple studies that have looked at it for migraines with encouraging results. These studies overall showed approximately a 50% good to excellent result from ONB’s for anywhere from 1 to 6 months.
How are they performed?
The physician sterilizes the injection site and injects in and around the area of greatest tenderness to palpation. Typically the injection contains both numbing medicine along with a steroid, such as Kenalog or Depo-Medrol.
What is injected?
Most physicians who perform occipital nerve blocks will inject a steroid medication along with a numbing medication. The studies performed have not delineated whether or not the addition of the steroid is absolutely necessary to make the results last longer. It has been postulated that simply the numbing medicine can break the “cycle of pain” in multiple forms of headaches. Since the answer is unclear and the risk of adding the steroid is low, it is typically included.
Should multiple occipital nerve blocks be performed?
As with most pain management injections, occipital nerve blocks typically do not produce effective results forever. Therefore, they will most likely need repeating once they wear off.
An additional consideration is that if the initial nerve block works slightly, it may be repeated sooner rather than later (2 week point versus 3 months or so) to potentiate the results and give more effective pain relief.
Do patients need to have tenderness around the region of the occipital nerves to obtain relief from these nerve blocks?
Occipital neuralgia by definition involves tenderness around the occipital nerves. Cluster, tension, and migraine headaches may not have tenderness in these areas. One study showed that almost half of patients with migraines did in fact have tenderness in the area of the nerves.
The answer to that question is it is unclear if tenderness needs to be present for the injection to work. However, multiple research studies have in fact shown that in patients with tenderness around the occipital nerves that an occipital block has a higher chance of success than otherwise.
This is not to say that if tenderness does not exist around the occipital nerve that the injection would be unsuccessful.