What to Know About Occipital Nerve Block

Medically Reviewed by Melinda Ratini, MS, DO on August 01, 2023
4 min read

An occipital nerve block is a procedure where your doctor injects a combination of pain medicine and steroids into the scalp on the back of your head, in the area around the greater occipital nerve. This is usually done to treat chronic headaches caused by an irritation to the nerve in the back of your head. The occipital nerve block procedure should give you quick relief from this type of headache.

An occipital nerve block treats 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 the eye, it may be caused by irritation of your occipital nerves. Your occipital nerves branch off from your spinal cord at the base of your skull. Pain that comes from irritation of these nerves is called occipital neuralgia

Migraines. An occipital nerve block can also help headaches that aren't directly caused by nerve irritation. Your occipital nerves may act as transmitters of pain signals that cause migraines. Blocking the signals from your occipital nerves may therefore remove the pain associated with them. 

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. 

Diagnostic procedure. 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 determine exactly where your pain is coming from and create a plan for more targeted therapy.

You'll have an intravenous (IV) line put in your arm. Your doctor will set up several monitors, including one for your heart. Your healthcare team will monitor your vital signs. Your doctor will give you IV medicine to reduce your anxiety and give you some pain relief.  

Your doctor will clean your skin where the injection will be given. A local anesthetic will be injected so that you won't feel any pain during the procedure. The medicine for the occipital block will be inserted near your occipital nerve through a small needle near the base of your skull. 

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.

The local anesthetic will wear off in about 4 hours. After that, you may feel a return of your usual level of pain until the steroid starts working. It may take up to 2 weeks for the steroid to start working. 

After your occipital nerve block, you can take 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: 

  • Fever over 100 degrees Fahrenheit
  • 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 6 to 8 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 2 weeks after the injection. Check your blood sugar more often than usual for the first few days after your injection. If it's elevated, contact the doctor who treats your diabetes about what you should do.

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 you experience relief but it's 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.