Overview Of Occipital Nerve Blocks
An occipital nerve block is a minimally invasive procedure that is performed in an outpatient setting. It can be effective for the management of various headache conditions.
Headaches are a common condition. There are various types of headaches, including:
- Episodic migraines
- Chronic migraines
- Episodic cluster headaches
- Chronic cluster headaches
- Tension headaches
- Occipital neuralgia
Prior to the occipital nerve block procedure, a topical anesthetic may be applied to the occipital area to minimize discomfort during the injection. The patient is then positioned to allow for access to the occipital region and the area to be injected is sterilized. A fine needle is inserted, and medication, including a corticosteroid often combined with a local anesthetic, is injected near the occipital nerve. These medications help to block pain signal transmission to the brain, thereby reducing headache pain.
After an occipital nerve block, the patient may report that the area has gone numb. The patient may be asked to stay in the office for 15 minutes to be monitored for any adverse reactions. The degree of pain relief may become evident during this time; however, the time to notice pain relief benefits varies from one person to the next. While some may notice an instantaneous relief of symptoms, it may take others a couple of days to experience pain relief.
Occipital nerve blocks inhibit the pain signals that are sent to the brain that are normally processed and perceived as headache pain. The pain relief experienced from an occipital nerve block varies among patients and may last up to several months. Patients can have repeat occipital nerve blocks to manage their headache pain symptoms.
Research Into Occipital Nerve Blocks
Occipital nerve blocks are often recommended to patients who have moderate to severe headache pain that has not responded to traditional medical management, such as oral analgesics.
Multiple studies have shown that occipital nerve blocks are successful in treating patients with occipital neuralgia, cervicogenic headache, and cluster headache. Additionally, there is some evidence to suggest that this procedure may be beneficial for the treatment of migraine. Furthermore, occipital nerve blocks may play an important role in rescue treatment, and in the treatment of medication over-use headache; however, further research is needed to confirm this finding.
Preliminary studies suggest that occipital nerve blocks are not an appropriate treatment for tension headache, hemicranias continua, and chronic paroxysmal hemicranias; however, its’ use in these cases is not completely excluded.
Occipital neuralgia is a neurological condition that arises due to dysfunction or damage of the occipital nerves. The symptoms of occipital neuralgia are often confused with migraine or other types of headache syndromes; however, occipital neuralgia is a distinct condition that requires an accurate diagnosis for successful management.
Symptoms of occipital neuralgia include intense pain that can be sharp or jabbing, and can feel like an electrical shock in the back of the head as well as the neck. Other symptoms experienced by patients with occipital neuralgia include:
- Aching, burning, and throbbing pain that commonly arises from the base of the head and radiates to the scalp
- Pain on one or both sides of the head
- Pain behind the eye
- Light sensitivity
- Scalp tenderness
- Painful neck range of motion
Cluster headaches are quite uncommon and involve an intense burning or piercing type pain that is throbbing and constant. Often the pain is severe and located behind or in the eye region. The term “cluster” is used as the headaches occur in a cluster or group of attacks over an extended period of time. They tend to occur one to three times per day during a cluster period, and the cluster period can last from two weeks to three months.
Cluster headaches may disappear suddenly and go into remission for months or years. A recent study investigating the effectiveness of occipital nerve block for the treatment of cluster headache found that 42% of the study participants were completely pain-free following the procedure; furthermore the pain relief benefits lasted up to 504 days.
Cervicogenic headache refers to a type of headache that originates from a problem in the cervical region. They can occur due to a wide range of problems, including arthritis and trauma. Cervicogenic headaches are a common cause of headaches that occur on a daily basis. Signs and symptoms of cervicogenic headaches include pain that is usually on one side of the head, dull or piercing type pain that starts in the back of the head and radiates toward the forehead or temple region, headaches that occur with stiffness and pain in the neck, headaches that occur with stiffness or pain in the shoulders, mild light and sound sensitivity. Additionally, some patients may have nausea and vomiting with severe headache pain.
It is believed that cervicogenic headaches are caused by neck pain, as there is an area in the upper part of the spinal cord where the sensory nerve fibers from the neck meet the sensory nerve fibers from the trigeminal nerve. The trigeminal nerve sends signals that are related to headaches, which results in referred pain.
In addition to treatment of headache symptoms, occipital nerve blocks may also be used as a diagnostic tool. A physician may utilize an occipital nerve block if occipital neuralgia or a similar condition is suspected. If the patient has a positive response to the block, it is probable that they do have a condition associated with damage or dysfunction of the occipital nerve and therapeutic treatment with this procedure may be advised.
What Are The Risks Of Occipital Nerve Blocks?
After an occipital nerve block, a patient may experience discomfort and tenderness at the injection site. This should subside within a couple of days following the injection. Other side effects that may be experienced following an occipital nerve block include infection or bleeding at the injection site, hematoma, adverse reactions to corticosteroids (i.e. swelling, skin discoloration, and emotional disturbances), and adverse reactions to anesthetic medication (i.e. temporary headache, nausea, sensory changes, and chest discomfort).
Rarely, a neurological complication known as transient facial palsy may occur. However, this is temporary and usually resolves within four to five hours after the injection. This complication is believed to be due to the unintended spread of the anesthetic solution along tissue planes.
If you would like to learn more about occipital nerve blocks, please review the links to the literature below. Additionally, if you suffer from headaches, migraines, or occipital neuralgia and are curious to know if an occipital nerve block may be a suitable treatment option for your condition, you are encouraged to speak to your physician. They can address any further questions or concerns that you may have which will help you to make an informed decision about your healthcare.