Occipital Nerve Blocks

What is an Occipital Nerve Block?

An occipital nerve block (ONBs) is an injection of a steroid – usually Lidocaine—or another medication into the greater or lesser occipital nerves, which are located just above the neck area on the back of the head. Occipital nerve blocks can be performed at a single level or at multiple levels.

 

What are the indications for an Occipital Nerve Block?

Occipital nerve blocks are primarily done in order to suppress chronic cervicogenic headaches, pain that arises from the neck or the base of the skull, along with spondylosis of the cervical facet joints, sensations of shooting, zapping, stinging, or burning in the back or one side of the head, etc. Discomfort usually extends to involve the temple, forehead, top of the head, eye, etc.

 

How do Occipital Nerve Blocks work to control my pain?

Signals must be conveyed to the brain for individuals to detect them. The greater and lesser occipital nerves –which arise between the first and second cervical vertebrae’s—supply touch, pain, and temperature sensations along the back of the scalp and top of the head to the brain. Sometimes blocking, or numbing, the occipital nerve can reduce any onset of pain. The steroid injected during an occipital nerve block is intended to reduce inflammation and swelling around the occipital nerves. This, in turn, may reduce symptoms caused by irritation or inflammation of the nerves and surrounding structures.

 

What should I expect during the procedure?

A local anesthetic will be injected into your skin to make the intended area numb. Then, a specifically designed needle will be inserted through the numbed skin and advanced into the specific foreman using fluoroscopy (live x-rays) to guide the needle. Once the needle is in the proper location, a small amount of contrast will be injected under live X-ray to ensure the medication will spread properly. A steroid will then be inserted into the area surrounding the nerve. Once the injection is complete, the needle will be withdrawn, and a dressing will be placed over the injection site.

 

What are the risks and side effects?

Complications for this procedure are relatively rare. Because treatment will be given near sensory nerves, you may experience temporary numbness over the regions affected by the nerves. Also, if the local anesthetic were to diffuse into areas close to the upper spinal cord or lower brain stem, brief difficulty in swallowing and speaking can occur–hours at most. Generally, a needle entering the skin can pose the risk of bleeding or infection. If bleeding accumulates inside the body, it forms a hematoma, and if the hematoma pushes against structures of the spine, surgery may be required to evacuate it.

Allergic reactions can occur to any of the medications used. If you have a known allergy to any medications, especially x-ray contrast dye or local anesthetics, please notify our staff before the procedure takes place. Individuals who are on blood thinning medication, active infections, or those with poorly controlled diabetes or heart disease are advised to delay having an occipital nerve block till their medical condition is improved.

 

How long does it take for the procedure to work?

Immediate pain relief in the hours after the procedure is most likely as a result of the local anesthetic. Pain, such as a sore head, may occur for one to two days, and this is due to the needle that was inserted as well as any irritation from the steroid itself. You should notice the steroid working between 3 to 5 days after the procedure and its effects can last between several days to a few months. If the initial injection does not relieve the symptoms, a second may be recommended. Please note that in a six-month period, no more that three occipital nerve blocks should be performed as it can significantly increase the risk of side effects. This injection may work very well for pain in certain areas but not other areas; areas of pain that do not respond may need other treatments, which you can discuss with your doctor.

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