Occipital Nerve Block

Written by Stephanie Langmaid
Medically Reviewed by Zilpah Sheikh, MD on December 05, 2024
6 min read

An occipital nerve block is a procedure where your doctor injects a combination of pain medicine and steroids into the scalp at the back of your head. This is usually done to treat chronic headaches caused by irritation to the nerves in this area. An occipital nerve block can offer quick relief from this type of headache.

The occipital nerve is actually a group of nerves that give you feeling in your scalp. They branch off from larger nerves in your spinal cord. There are three kinds of occipital nerves:

Greater occipital nerves. These are the largest of the occipital nerves, which give you feeling from the base of your skull to the top of your head and your ears.

Lesser occipital nerves. These run up the back of your skull on each side, giving feeling to that area and the outer part of your ears.

Third occipital nerves. These are located in the lowest part of the back of your head, where your spine meets your skull.

Many things can cause damage or irritation to these nerves, such as tight neck muscles or a head injury. The greater occipital nerve is often the nerve involved in headache pain, and a greater occipital nerve block is the most commonly used procedure for treating headaches.

Occipital nerve blocks treat different types of head pain, including: 

Occipital neuralgia. If you have a headache that starts at the base of your skull and goes around one side, up to your forehead, temple, and eye, it may be caused by irritation of your occipital nerves. Pain that comes from irritation of these nerves is called occipital neuralgia.

Migraine. An occipital nerve block can also help headaches that aren't directly caused by nerve irritation. Your occipital nerves may transmit pain signals that cause migraines, and blocking these signals may therefore remove the associated pain. 

Cluster headaches. Cluster headaches are one of the most painful types of headaches. They occur in clusters, or cyclical patterns. Cluster headaches may wake you up in the middle of the night. They cause intense pain around one eye on one side of your head.

Cervicogenic headaches. These headaches come from issues with the nerves in your neck. You usually feel this pain on one side of your head, and it may hurt worse when you move your neck. It can be caused by an injury like whiplash or conditions such as arthritis or a slipped disk.

An occipital nerve block can also be used to diagnose other issues. It can be hard to tell the difference between pain that starts in your occipital nerves and pain that comes from another part of your spine. An occipital nerve block can help your doctor find out exactly where your pain is coming from and create a plan for more targeted therapy.

An occipital nerve block is usually an outpatient procedure, meaning you'll go home shortly afterward and won't spend the night in the hospital.

You'll have an IV line put in your arm. Your doctor will set up several monitors, including one for your heart. Your health care team will monitor your vital signs. 

You'll be awake for the procedure, but your doctor will give you IV medicine to reduce your anxiety and give you some pain relief. You'll either sit up or lie on your stomach with your head tilted forward.

Your doctor will choose the correct spot for the injection, either by feeling the bones at the base of your skull or using an ultrasound machine, and clean your skin in that area. They'll use a very thin needle to inject the medicine for the occipital block near your occipital nerve.

Your headache may get worse briefly when the medicine is injected. This is a sign that the medicine is going to the right place. The procedure usually lasts around 15 minutes.

What steroids are used for occipital nerve block?

The steroid medications most commonly used in occipital nerve blocks are:

  • Betamethasone
  • Dexamethasone
  • Methylprednisolone 
  • Triamcinolone

These drugs are usually combined with either or both of the numbing medications lidocaine and bupivacaine.

The local anesthetic will wear off in about four hours. After that, you may feel a return of your usual level of pain until the steroid starts working. That may take up to two weeks. 

After your occipital nerve block, you can take an over-the-counter pain medicine such as acetaminophen or ibuprofen. You can also take any pain medicine your doctor has prescribed for you. Call your treatment center if you have any of the following symptoms: 

  • A fever over 100 F
  • Swelling, redness, or bleeding at the injection site
  • Chills
  • Any new or unexplained symptoms 

If the occipital nerve block doesn't provide any pain relief for you, your doctor will work with you to find other treatment options.

Side effects from an occipital nerve block are usually temporary and go away within six to eight hours. Side effects can include: 

  • Pain at the site of the injection
  • Infection
  • Bleeding
  • Weakness
  • Dizziness
  • Numbness
  • Lightheadedness

If you have diabetes, the steroids used in the occipital nerve block can cause your blood sugar levels to be elevated for up to two weeks after the injection. Check your blood sugar more often than usual for the first few days after your injection. If it's high, contact the doctor who treats your diabetes about what you should do.

An occipital nerve block is generally considered to be a safe procedure, but it's possible to have dangerous complications, such as:

  • A sudden drop in blood pressure
  • Swelling in your face
  • Trouble breathing
  • Nerve damage
  • Broken blood vessels 
  • Worsening headache

Some people may also have a reaction to the medications used in the procedure.

There's no way to predict how long an occipital nerve block will last. It varies for each person. Some people experience pain relief that lasts for months. For others, it's not effective or lasts only a few days. If the relief is short-lived, you may want to try again.

There's a limit to how many steroid injections you should have. Your doctor will talk to you about how often you can have them.

The general guideline is to wait at least three months between treatments.

The cost of an occipital nerve block varies widely. It depends on things like where you live, who's doing the procedure, and whether you have health insurance.

If your doctor recommends the procedure, some amount of the cost may be paid for by your insurance. Check with your insurance company about your coverage and what you'll have to pay out of pocket.

An occipital nerve block is a procedure that can treat some kinds of headache pain, including occipital neuralgia, migraine, and cluster headaches. A doctor injects a combination of numbing medication and steroids into your scalp at the base of your skull. Some people feel relief right away, but it can take several days for the treatment to take effect.

How many injections for occipital nerve block?

It may take several injections to get relief from your headache pain. During one procedure, you may have a shot on one side of your head or a shot on each side of your head. If the treatment doesn't seem to help, your doctor may repeat the procedure in a few weeks. The general guideline is to wait at least three months between injections.

Do nerve blocks damage nerves?

It's rare, but sometimes nerve blocks do cause nerve damage. In most cases, the damage is temporary.

Can I go back to work after an occipital nerve block?

Ask your doctor what they recommend. You can usually go back to your normal activities the next day if not sooner.

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