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Occipital Nerve Block

What is an occipital nerve block

An occipital nerve block is an injection targeted toward the occipital nerves that are located in the back of the head at the base of the skull. The injection itself typically includes local anesthetic and steroid medication.

What is the purpose of an occipital nerve block?

The steroid component of the injection is helpful in reducing inflammation, irritation and swelling around the occipital nerves, which helps reduce overall pain. Certain headaches located in the back of the head, including tension headaches and migraines, can potentially respond well to occiptal nerve blocks.

How long does the occipital nerve block take?

Occipital nerve blocks typically take only a few minutes to perform.

What is actually injected?

The injection itself consists of a local anesthetic and a steroid medication.

Will the occipital nerve block hurt?

Prior to the occipital nerve block, we use numbing medicine at the skin using a very thin needle. This often feels like a “pinch and a burn” to numb the skin before entering the targeted area. Patients don’t usually need intravenous sedation for this procedure as it can be done easily under local anesthetic.

Will I be “put out” for the occipital nerve block?

Typically not. This procedure can often be completed under local anesthesia

How is the occipital nerve block performed?

The patient will be seated or lying down on the stomach. The skin on the back of the head is cleaned with antiseptic solution, the skin overlying the target is cleaned and the injection is completed.

What should I expect after the occipital nerve block?

The occipital nerve block may cause your headache symptoms to completely or partially subside immediately. This is a result of the local anesthetic in the injection taking effect. The local anesthetic lasts only for a few hours. After this, your pain may return and the injection site may be sore for a day or two. You may begin feeling the effect of the steroid and gradual pain relief beginning 2-7 days after the injection.

What should I do after the occipital nerve block?

After the occipital block, you will rest for a few minutes in the office. After this, we will assess you and make sure you are safe to drive home. We advise you to take it easy for the rest of the day and only gradually increase your activity level. You can apply ice to the injection site if you feel soreness over the next 1-2 days after the injection.

Can I go to work to work the next day?

Unless there are side effects or complications, you should be able to return to work the next day.

How long does the effect of the medication last?

The immediate pain relief is typically from the effects of the local anesthetic that was injected. This effect may wear off in a few hours and a feeling or soreness may kick in. The effect of the steroid starts working in about 2-7 days after the injection and its effect can last for several days to a few months.

How many occipital nerve blocks do I need to have?

The number of injections you may need varies. If you need more than one injection, the injections are done about one week apart. If the first injection gives you partial relief, you may be recommended to have a second injection. If you get complete response to the injections, you may be recommended for additional injections when the symptoms return.

Can I have as many occipital nerve blocks as I need?

We typically do not perform more than 3 occipital nerve blocks within a six-month time period. With increasing number of injections, there is a higher incidence of side effects from the steroid. If a patient is not obtaining complete long term relief, we may consider additional treatment options.

Will the occipital nerve blocks help me?

It is difficult to predict with 100% accuracy how a patient will respond to occipital nerve blocks. The first injection is often also used diagnostically to determine whether or not pain is actually coming from the occipital nerves. As a general rule, patients who typically have pain that is milder and has been present for a shorter amount of time may respond better than those with more severe, long standing pain.

The most common side effect of the procedure is pain and soreness, which typically subsides with time. Other, more rare, risks include infection, bleeding and worsening of symptoms. There are risks also associated with the medications that are injected as well. For instance, steroids could cause weight gain, increase in blood sugar and the suppression of the body’s own ability to produce cortisone. Serious side effects are uncommon.

What are the risks and side effects of occipital nerve blocks?

The most common side effect of the procedure is pain and soreness, which typically subsides with time. Other, more rare, risks include infection, bleeding and worsening of symptoms. There are risks also associated with the medications that are injected as well. For instance, steroids could cause weight gain, increase in blood sugar and the suppression of the body’s own ability to produce cortisone. Serious side effects are uncommon.

Who should not have an occipital nerve block?

Patients who have an allergy to any of the medications that are injected, are on blood thinners as a part of their medication regimen, have an active infection or have poorly controlled diagnoses such as diabetes or heart disease may not be good candidates for a joint injection. Your physician will determine whether you are a safe candidate.

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