Occipital Nerve Block for Chronic Headaches & Migraines

Occipital Nerve Block

An occipital nerve block places local anesthetic, sometimes with corticosteroid depending on the clinical situation, near the greater and/or lesser occipital nerves. It may be used diagnostically and therapeutically for selected patients with occipital neuralgia, cervicogenic headache, or headache with a clinically important occipital pain component.

The block is not based on the assumption that every migraine, cluster headache, or chronic headache originates from the occipital nerves. Patient selection depends on the pain distribution, examination, diagnosis, and prior treatment.

What to Expect

The injection is typically performed as an outpatient procedure. Ultrasound or landmark-guided techniques may be used depending on anatomy and physician preference. Relief can be temporary and varies considerably; a successful block may also provide diagnostic information when a more durable nerve-targeted procedure is being considered.

Risks

Potential risks include temporary soreness, bleeding, infection, medication reaction, dizziness, numbness, temporary worsening of pain, and uncommon nerve or vascular injury. Alopecia or skin changes can occur after superficial corticosteroid exposure.

What to Expect During Your Procedure

Please arrive at our clinic 15 minutes before your appointment. A designated driver is not required for this procedure, but you are welcome to bring one for comfort. Before we begin, your provider will review the benefits and risks of the procedure with you in detail, answer any remaining questions, and have you sign a consent form. You will then be positioned in preparation for the injection.

The injection site and surrounding skin will be cleaned with an antiseptic solution to reduce the risk of infection. Using ultrasound guidance, your provider will identify the precise location for the injection. Lidocaine, a local numbing medication, will be administered first to minimize discomfort. Once the area is numb, each occipital nerve will receive an injection of bupivacaine, a long-acting anesthetic. Many patients report meaningful relief shortly after the procedure, though individual results vary.

After the injection, you will be observed for an additional 10 to 15 minutes to ensure your comfort and safety. Our staff will then schedule your post-procedural follow-up before you leave.

What to Expect After Your Procedure

• Reduction in chronic headache symptoms for many patients
• Pain relief that may last from several days to several months
• Mild, short-term soreness or swelling at the injection site is common and typically resolves within a day or two

Possible Risks of an Occipital Nerve Block

As with any injection-based procedure, there are potential risks to be aware of. These may include:

• Misplacement of the needle
• Minor bleeding at the injection site
• Allergic reaction to the medication
• Infection
• Nerve irritation or injury (uncommon)
• Temporary worsening of pain

Your provider will review all relevant risks and benefits with you personally during your consultation, so you can make a fully informed decision.

Is an Occipital Nerve Block the Same as Radiofrequency Ablation?

No — though the two procedures are closely related and often used together as part of a broader treatment plan. An occipital nerve block uses anesthetic medication to temporarily interrupt pain signals from the occipital nerves, typically providing relief for several days to several months. Occipital radiofrequency ablation (RFA) is a longer-lasting procedure that uses controlled heat to disrupt the same nerves, with relief that can last 6 to 12 months or more for some patients.
At Solutions in Pain, we often begin with a nerve block for two reasons. First, the block itself can provide meaningful short-term relief. Second, a successful block helps confirm that we’ve identified the correct nerves as the source of your pain — which is important information before moving forward with a longer-lasting procedure. If you experience good relief from one or more occipital nerve blocks but find that the pain returns, you may be a candidate for occipital radiofrequency ablation as a next step.
Your provider will discuss both options with you during your consultation and help you decide which approach — or combination of approaches — is most appropriate for your situation.