Occipital Nerve Block (ONB)


What is an occipital nerve block?

An occipital nerve block is an injection of a local anesthetic and steroid around the greater occipital nerves that are located on the back of the head just above the neck area.


Who should have an occipital nerve block?

Many patients with chronic headache report that their pain typically arises from the neck or, more specifically, the base of the skull. Often that pain arises on one side or the other and extends forward to involve the top of the head, the temple, the forehead, the eye or some combination thereof. These are termed cervicogenic (i.e., “born of the neck”) headaches. A lot of patients with chronic daily headaches also report significant benefit from it.

Residing in those areas of the skull base are the occipital nerves. Irritation/inflammation of those nerves may cause a specific type of “neuralgiform” pain: occipital neuralgia. More commonly, however, those nerves serve as major “on-ramps” to the “superhighway” upon which travel the pain signals that produce migraine and other types of headache. If one can block traffic on these busy on-ramps, then it may be possible to halt the flow of pain signal on the superhighway and thus-at least temporarily-halt head pain.

How is the occipital nerve block performed?

The blocks themselves are relatively simple to perform. Your physician will use a small needle to inject a solution into the area around the nerves; the composition of that solution differs according to physician experience and preference but most often contains a long-acting local anesthetic and a steroid anti-inflammatory drug. Insertion of the needle is not especially painful, but infusion of the solution may cause temporary discomfort.

How quickly can relief occur?

Pain relief can occur with startling rapidity, frequently within 15 minutes of the block(s). For those who experience relief, the duration of the therapeutic response varies widely: a day or so up to weeks sometimes even months.