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

OCCIPITAL NERVE BLOCK

An occipital nerve block numbs the greater or lesser occipital nerve at the base of the skull. It tests whether your headache is coming from that nerve. Where it is, the relief frequently outlasts the anesthetic. 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 is an occipital nerve block?

The greater occipital nerve comes from the C2 dorsal ramus (a nerve branch at the second neck level). It 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. Both can get entrapped (pinched) where they pass through muscle. Or both can be sensitized by input from the upper cervical segments.

Numbing the nerve does two jobs at once. It tests whether your headache is coming from that territory. And where it is, it frequently gives relief lasting well beyond the anesthetic. That is why this is one of the few procedures that is genuinely both diagnostic (a test) and therapeutic (a treatment).

What is an occipital nerve block used for?

The clearest indication (reason to use it) is occipital neuralgia — sharp, shooting, electric pain in the area the nerve supplies. There is often a tender point where it crosses the skull base, and altered feeling in the scalp above it.

The second is cervicogenic headache. Here the upper cervical segments drive the headache, and the occipital nerve carries part of the signal. A systematic review of greater occipital nerve blockade in cervicogenic headache supports meaningful short to medium-term benefit with a good safety profile. That 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.

How is an occipital nerve block performed?

• Seated, leaning slightly forward. The nerve is found by landmarks and tenderness, or by ultrasound where the anatomy is unclear.
• A small amount of local anesthetic, with or without a steroid. That depends 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 area the nerve supplies for a few hours is expected. It confirms the medicine 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. That is a genuinely useful negative.

Say the relief outlasts the anesthetic by days or weeks. Then the nerve was sensitized, not simply the messenger, and a course or a longer-acting option becomes reasonable. Say it wears off precisely with the anesthetic and the headache returns unchanged. Then the driver is upstream — usually the C2-3 facet joint, which is a different target.

How many times can you have an occipital nerve block?

We will not run an endless series of occipital blocks. Repeated steroid at the same site thins tissue and causes local depigmentation (skin lightening) and atrophy (shrinking). 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.

What is occipital neuralgia?

True occipital neuralgia is a nerve pain and behaves like one. It is sharp, shooting or electric, in the area the nerve supplies. It frequently comes with altered feeling 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. That kind 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. 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. Say a block abolishes the pain for two weeks and then lets it return. It has answered the diagnostic question definitively — the pain comes from that territory. And it has bought a window in which the loading and posture work has a chance of holding.

What we do next is look upstream rather than repeat it endlessly. A block that needs repeating every few weeks is telling you the upstream driver has not been addressed. 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 lasts longer than numbing the nerve downstream of it again and again.
• Pulsed radiofrequency to the occipital nerve is an option. It has a modest evidence base for occipital neuralgia, and we will describe it as modest.
• Preventive medication, where the picture looks more like migraine than neuralgia.
• 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 (a flat tendon sheet) on its way to the scalp. Both of those are muscles that spend the day holding a head up. Both become tight and tender in the posture patterns described on work-pattern neck pain.

That is the mechanical link between a desk and a headache at the back of the skull. It is also why a block that works is frequently followed by a talk 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 numbs a specific nerve and answers a question about it. Botox is a preventive treatment for chronic migraine. It is 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. It moves the workup toward the upper cervical joints or a primary headache disorder. Trigeminal neuralgia.

What are the side effects of an occipital nerve block?

The one almost everyone notices is numbness of the scalp over the back of the head for a few hours. That is expected, and it shows the medicine reached the right place. The injection itself is a brief sting. The real concern is repetition. Repeated steroid at the same spot can thin the tissue and lighten or shrink the skin there. That is why we do not run an open-ended series.

What should I expect after an occipital nerve block?

You drive yourself home, because there is no sedation. Expect your scalp to feel numb for a few hours. Pay attention to your headache during the first hour and over the next few days. If it eases while the scalp is numb, the nerve is involved. If nothing changes in that window, the pain is probably coming from somewhere else.

Can an occipital nerve block help migraines?

It is not a treatment for migraine in general. Its clearest uses are occipital neuralgia and headaches driven by the upper neck. When the picture looks more like migraine, the next step is preventive medication, and chronic migraine has its own treatment with Botox, which is a different indication with different evidence.

Why did my headache come back when the block wore off?

That is the most common result, and it is not a failure. Relief that lasts days or weeks tells us the pain comes from that nerve’s territory. If the headache returns exactly as the anesthetic fades, the driver is usually further up, most often the C2-3 facet joint, and treating that joint lasts longer than numbing the nerve again and again.

What kind of doctor performs an occipital nerve block?

Interventional pain physicians, neurologists and headache specialists all perform it; what matters more than the specialty is whether the result is read as a test. Here the block is done by Dr. Padda, board certified in pain medicine and interventional pain management, after an examination of the upper neck decides whether the nerve or a joint above it is the better target. Dr. Padda’s training and the practice he runs.

Will an MRI show occipital neuralgia?

It will not show the neuralgia itself, because an irritated occipital nerve looks normal on a scan. The diagnosis comes from the pattern of the pain and the tender spot at the base of the skull, and it is confirmed when numbing the nerve stops the pain. Imaging earns its place when something else is suspected, such as arthritis in the C1-C2 joint or a new neurological sign. Why a normal scan and real pain are not a contradiction.

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.