Overview of Occipital Nerve Block
About 15% or more of people suffer from serious, life-disrupting headaches. Headaches are the tenth most common health issue and the top nervous system disorder. About 1.4 to 2.2% of people across the globe experience headaches at least 15 days in a month. This painful condition can significantly impact the quality of life and leads to considerable social and economic costs. That’s why more and more experts are focusing on how to manage headache pain.
One technique that is gaining attention for treating headaches is the greater occipital nerve block. The greater occipital nerve is a nerve that runs through the upper neck and back of the head. If this nerve isn’t working correctly, it can cause several types of headaches, including classic migraines, occipital neuralgia (a type of severe headache at the back of the head), cervicogenic (headaches that originate from the neck), and cluster headaches (a severe type of headache that occurs on one side of the head). The nerve block can offer significant pain relief as a primary treatment for headaches, and can also be used if other treatment methods haven’t worked. However, how much it helps can vary greatly from person to person and is hard to predict.
When this nerve block treatment works, the pain usually starts to get better after about 20 to 30 minutes, and this relief can last from a several hours to several months. For people who regularly suffer from severe headaches, this treatment can greatly improve their quality of life. If the nerve block needs to be done more than three times in six months, it may be time to consider other treatment options.
Anatomy and Physiology of Occipital Nerve Block
The GON-block is a type of treatment for pain that can safely and effectively be performed by a health professional who understands the structure of the head and neck. The treatment involves blocking the function of three nerves, known as the occipital nerves, which come from the spinal nerves named C2 and C3 and provide sensation to the back of the head. These three nerves are called the greater occipital nerve (GON), the lesser occipital nerve (LON), and the third occipital nerve (TON).
The greater occipital nerve is the biggest of these three nerves and provides sensation to the back of the head. The nerve specifically originates from a major segment of the C2 spinal nerve, travels through specific muscles in the neck, and finally becomes visible beneath the skin near the occipital artery at the back of the head. Due to its winding path, this nerve can sometimes get irritated or compressed, causing pain.
Simultaneous neck pain and headache often occur because of the greater occipital nerve’s direct connection to the tribemino-cervical complex (TCC). This is a network involving the greater occipital nerve and other nerve centers that integrates sensations from the head and neck. This network allows a treatment like the GON-block to be a reasonable choice for quickly treating and preventing various types of headaches.
Why do People Need Occipital Nerve Block
Blocks or treatments targeted towards a nerve in the back of your head, known as the greater occipital nerve, can be used to mainly treat headaches. These treatments are typically used when other headache relief methods haven’t worked.
This type of nerve block treatment can effectively and safely help with a variety of headaches. These include headaches due to irritation of the occipital nerve located at the back of the head; migraine, a type of headache that causes severe throbbing pain or a pulsing sensation, usually on one side of the head; post-dural puncture headache, a complication of puncture to the covering of the spinal cord, which can cause severe headaches; cervicogenic headache which is caused by issues in the neck; and cluster headache, a severe type of headache that tends to occur in clusters or cycles.
This nerve block treatment can also help alleviate associated symptoms resulting from nerve irritation, including ringing in the ears (tinnitus), and ear pain (otalgia).
The treatment is most successful in patients who experience extreme sensitivity of the scalp, known as allodynia, and those whose pain can be recreated by pressing on the greater occipital nerve. It is also a viable treatment option for elderly and pregnant individuals who are unable to receive other primary treatments due to other medical conditions they might have.
When a Person Should Avoid Occipital Nerve Block
When a doctor performs a “nerve block” on the occipital nerve (a nerve located in your head), it’s generally considered safe and easy to handle for the patient. However, there are some situations in which a doctor would not perform this procedure:
The patient doesn’t agree to it, is allergic to the anesthetic (the drug used to numb the area), has an open wound in their head, or has an infection where the doctor would need to do the procedure. A nerve block is also not done at a place in the head where surgery has been performed to avoid the risk of the drug spreading inside the head.
There are other conditions that need to be considered before doing the procedure. These include Coagulopathy (a condition that prevents blood from clotting properly), having had a condition called the Arnold Chiari malformation (a problem with the brain and spinal cord that can cause balance and muscle problems), or if the patient can’t stay still when lying face down or sitting.
Equipment used for Occipital Nerve Block
The GON-block is a type of procedure that can be done quickly, easily, and without costing too much. It requires only basic equipment, and the doctor has the choice to inject a numbing medicine alone, or a mix of this numbing medicine and a type of medication called a steroid. Research says that for migraines, it doesn’t matter if the numbing medicine is used alone or with a steroid; both methods work the same in the short and long term. But when it comes to cluster headaches, neck-originating headaches, and headaches after a spinal tap, adding steroids seems to work much better.
Here is a list of equipment needed for a single GON-block procedure:
- A 5 cc syringe
- A needle (25-gauge)
- Povidone-iodine or chlorhexidine for disinfection
- Anesthetics, meaning numbing medicines
- Lidocaine 2% (2 mL)
- Bupivacaine 0.5% (2 mL)
- Anti-inflammatory medications, which help reduce swelling
- Methylprednisolone 40 mg/mL (2 ml)
- Dexamethasone 2 mg/mL (2 ml)
The total amount of fluid injected shouldn’t exceed 4 mL. If both lidocaine and bupivacaine are used together, they should be in a ratio of 1 to 1 or 1 to 3.
Who is needed to perform Occipital Nerve Block?
A nerve block on the greater occipital (back part of the head) should be done by a medical professional who knows about the structure and parts of the head and neck and who has received training in giving local anesthesia (medicine that numbs a specific area). A nurse or nursing assistant can help adjust and make you comfortable during the procedure. The nursing team would also keep an eye on your vital signs, like pulse and breath rate, and be on the lookout for any signs that you’re not reacting well to the procedure.
Preparing for Occipital Nerve Block
Before the doctor can perform a procedure called a GON-block, they must first get permission from the patient or the person who makes health decisions for the patient. This permission comes in the form of a written agreement, known as informed consent. It’s crucial that the doctor explains all the possible risks and benefits of the procedure to the patient.
After the patient has given their consent, they will be taken to an examination room where their health can be closely watched with a monitor. To make sure everything goes smoothly, all the required equipment and medicines for the procedure will be prepared and ready at the patient’s bedside.
How is Occipital Nerve Block performed
The Greater Occipital Nerve (GON) block can be done on one side or both sides of your head. It’s still unclear which method is better, as both have been found to be equally helpful.
To give you an idea of how the procedure works, here is a simple step-by-step breakdown:
- First, you will be placed in a comfortable position either sitting down or lying flat on your stomach with your neck slightly bent.
- Next, the doctor will feel the back of your skull to find the right place to inject the medication. They are specifically looking for two prominent bones – the occipital protuberance (a bump on the back of your skull) and the mastoid process (a bone just behind your ear).
- After locating these bones, the doctor will find the exact location of the GON which is usually about a third of the distance from the occipital protuberance to the mastoid process. Imagine it as being about 2 cm down and 2 cm to the right or left of the bump at the back of your skull.
- The area is then cleaned using a sterilizing solution – typically something like povidone-iodine or chlorhexidine.
For the injection part, the doctor will use a syringe filled with a local anesthetic (a medication that numbs the area). They will insert the needle at an angle pointing towards the GON. The needle will be gently pushed until it touches the periosteum (the layer of tissue covering the skull). The needle is then pulled back just a tiny bit and the doctor will check to make sure the needle isn’t touching the occipital artery. After these checks, the anesthetic is then slowly injected. This may be done in a fanning motion, or the injection could be given directly without the fanning. Once the medication has been injected, the needle is removed and pressure is applied to the injection site for about 5-10 minutes.
The way each person responds to a GON block can be very different, and it’s hard to predict exactly how you’ll feel. If the treatment works, pain relief generally starts 20 to 30 minutes after the injection and can last anywhere from a few hours to several months.
Possible Complications of Occipital Nerve Block
A nerve block in the back of the head, also known as a greater occipital nerve block, is a generally safe procedure. The most common side effects are usually mild and don’t last long. These can include pain, redness, and swelling where the injection was given. Some people might also feel dizzy, have spinning sensations (vertigo), feel numb, or light-headed. In some cases, people might faint or feel like they’re about to, have swelling in the face, find swallowing difficult for a short while, have worsened headaches, or even injure a nerve or blood vessel. There’s also a small risk of getting an infection, a build-up of blood outside the vessels (hematoma), and if a steroid is used, hair loss at the injection site.
The procedure uses a small amount of anesthetic. However, it’s always important to watch out for and prevent a harmful reaction to the anesthetic (like lidocaine or bupivacaine). Such reactions can cause a rare blood condition called methemoglobinemia, low blood pressure, seizures, or unusual heart rhythms.
The risk of complications can be lowered by carefully checking for blood before injecting an anesthetic and closely observing the patient after the nerve block to spot and manage new symptoms.
What Else Should I Know About Occipital Nerve Block?
Headaches are a common issue faced by people of all ages and can affect many aspects of life. They can be very painful, lower a person’s overall wellbeing, and often lead to significant societal costs.
One effective way to manage both short-term and long-lasting headaches is a treatment called a greater occipital nerve block (GON-block). This treatment involves blocking pain signals from the nerve located at the back of your head. It’s a fairly simple procedure that requires minimal equipment, making it a safe option even for people dealing with various health issues.
The GON-block can be used on its own, or in combination with other pain relief methods that can be taken orally or via an injection. Using a variety of treatments can help to improve patient outcomes and provide better pain relief.
