It starts at the base of your skull and finishes behind your eye.

OCCIPITAL NERVE BLOCK

A headache that starts at the base of the skull and travels up the back of the head has a specific nerve behind it often enough to be worth testing directly.

What the block targets

The greater occipital nerve arises from the C2 dorsal ramus, pierces the muscles at the base of the skull and supplies the back and top of the scalp. The lesser occipital nerve covers the area behind the ear. Both can become irritated, entrapped where they pass through muscle, or sensitized by input from the upper cervical segments.

Anesthetising the nerve does two jobs at once. It tests whether your headache is coming from that territory, and where it is, it frequently provides relief lasting well beyond the anesthetic — which is why this is one of the few procedures that is genuinely both diagnostic and therapeutic.

Who it helps, and what the evidence shows

The clearest indication is occipital neuralgia — sharp, shooting, electric pain in the distribution of the nerve, often with a tender point where it crosses the skull base and altered sensation in the scalp above it.

The second is cervicogenic headache, where the upper cervical segments drive the headache and the occipital nerve carries part of the signal. Systematic review of greater occipital nerve blockade in cervicogenic headache supports meaningful short to medium-term benefit with a good safety profile, which is a more modest and more honest claim than the way this procedure is often sold.

It is not a treatment for migraine in general, and it is not a treatment for a headache nobody has characterized.

What it involves

• Seated, leaning slightly forward. The nerve is located by landmark and tenderness, or by ultrasound where the anatomy is unclear.
• A small volume of local anesthetic, with or without a steroid depending on the indication and how many blocks you have had.
• Under five minutes. No sedation, no fasting, and you drive yourself home.
• Scalp numbness in the distribution for a few hours is expected and is confirmation the injectate reached the right place.

How to read your own result

The useful observation is what happens in the first hour and over the next few days. Headache that substantially eases while the scalp is numb points at the nerve. Headache unchanged during that window points away from it, which is a genuinely useful negative.

Where the relief outlasts the anesthetic by days or weeks, the nerve was sensitized rather than simply the messenger, and a course or a longer-acting option becomes reasonable. Where it wears off precisely with the anesthetic and the headache returns unchanged, the driver is upstream — usually the C2-3 facet joint, which is a different target.

What we will not do

We will not run an indefinite series of occipital blocks. Repeated steroid at the same site thins tissue and causes local depigmentation and atrophy, and a block that needs repeating every few weeks is telling you the driver has not been found. That is a reason to re-examine, not to rebook.

Occipital neuralgia, which is not the same as a headache in that area

True occipital neuralgia is a nerve pain and behaves like one: sharp, shooting or electric, in the distribution of the nerve, frequently with altered sensation in the scalp above it and a tender point where the nerve crosses the skull base. Between the attacks there is often a duller background ache.

That is different from a headache that merely happens to be felt at the back of the head, which is more often referred from the upper cervical joints. The distinction matters because it changes what the block means: in true neuralgia the nerve is the problem, and in referred pain the nerve is only the messenger.

When it works and then wears off

This is the most common thing that happens and it is not a failure. A block that abolishes the pain for a two weeks and then lets it return has answered the diagnostic question definitively — the pain comes from that territory — and bought a window in which the loading and postural work has a chance of holding.

What we will not do is repeat it indefinitely. A block that needs repeating every few weeks is telling you the upstream driver has not been addressed, and that is a reason to look again at the C2-3 joint rather than to rebook.

What comes after a block that keeps working

• Address the upstream segment. If the C2-3 facet is driving it, treating that joint is more durable than repeatedly anesthetising the nerve downstream of it.
• Pulsed radiofrequency to the occipital nerve is an option with a modest evidence base for occipital neuralgia, and we will describe it as modest.
• Preventive medication, where the picture is more migrainous than neuralgic.
• Botulinum toxin, where the diagnosis is chronic migraine rather than occipital neuralgia — a different indication with different evidence.

The muscles the nerve has to pass through

The greater occipital nerve pierces the semispinalis capitis and then the trapezius aponeurosis on its way to the scalp. Both of those are muscles that spend the day holding a head up, and both become tight and tender in the postural patterns described on work-pattern neck pain.

That is the mechanical link between a desk and a headache at the back of the skull, and it is why a block that works is frequently followed by a conversation about how many unbroken hours you spend in one position.

What people ask about occipital blocks

How long does it last?

Anywhere from hours to months. A short duration is not a failure — it still answers the diagnostic question, which is what the first block is for. How a cervicogenic headache is identified.

Does it hurt?

A brief sting. It is one of the quicker and better-tolerated procedures done here, and it needs no sedation. The atlantoaxial joint. Scalp numbness for a few hours afterward surprises people more than the injection does.

Is it the same as Botox for headache?

No. The block anesthetises a specific nerve and answers a question about it. Botox is a preventive treatment for chronic migraine given as multiple small injections on a fixed schedule, with different evidence and a different purpose.

What if it does not work at all?

That is informative. It argues against the occipital nerve carrying your pain and moves the workup toward the upper cervical joints or a primary headache disorder. Trigeminal neuralgia.

Related reading

• Cervicogenic headache
• Cervical facet syndrome
• Botox for neck and headache
• Atlantoaxial joint injection
• Temporal arteritis
• What happens at the first visit

The shooting, seconds-long quality is the part that points here. Brief sharp neck pain and what separates its causes.