An occipital nerve block is an injection at the back of the head for occipital neuralgia and some persistent headaches.
What is an occipital nerve block?
We place local anesthetic, and most often a small dose of steroid, around the greater and lesser occipital nerves. That is where they cross the base of the skull.
What is an occipital nerve block used for?
- Occipital neuralgia
- Cervicogenic headache
- Post-traumatic headache after a crash
What to expect
- Quick: a few minutes, in the clinic room.
- Numbness over the back of the scalp for a few hours is expected.
- No driver needed for most patients.
What are the side effects of an occipital nerve block?
It is a superficial injection (close to the skin) with low risk. Expect numbness across the back of the scalp for several hours. Bruising at the injection site is common because the area has many blood vessels. A rare effect is a brief spell of dizziness. If steroid is used, a small patch of thin skin or color change at the site is possible.
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How we judge whether it worked
Relief within minutes confirms the occipital nerve as the source. So the block is a test as well as a treatment.
When relief substantially outlasts the anesthetic, for weeks or months, that is a good sign it can be repeated. When it lasts only hours and the pain returns, the upper cervical joints (the top joints of the neck) are usually the real source. Those are worth blocking instead.
What should I expect after an occipital nerve block?
No driver needed for most patients. Expect numbness across the back of the scalp for several hours and possible bruising, as the area has many blood vessels. Note how fast the pain changes. A fast response confirms the diagnosis. Do not press on the site for the rest of the day.
How is an occipital nerve block performed?
The greater and lesser occipital nerves come out at the back of the skull and give feeling to the scalp. We block them at the base of the skull, aimed by feel or under ultrasound. We use a small volume of local anesthetic and often a corticosteroid. Numbness over the back of the head follows within minutes and is expected. The procedure takes a few minutes and requires no sedation.
Who it suits, and who it does not
It suits occipital neuralgia, with its telltale sharp, shooting pain over the back of the head. It suits cervicogenic headache, which comes from the upper neck. And it suits some migraine patients whose occipital nerves are tender and involved. It is less useful for headache with no neck or occipital features. It is not a treatment for headache that comes mainly from inside the head.
What the evidence supports, and what it does not
Honest framing matters here. Some of these procedures have strong evidence behind them. Some have moderate evidence in well-chosen patients. Picking the right patients is usually what splits the studies that show benefit from those that do not. We will tell you which group fits what we propose. Where the evidence is mixed, we will say that too.
Common questions
How soon will I know if it worked?
Often within minutes for the local anesthetic effect. Any steroid benefit builds over several days.
Will my scalp go numb?
Over the back of the head, yes, most often for several hours. That numbness is confirmation the block reached its target.
Can this help migraine?
For some patients, yes. It helps most when the occipital nerves are tender and headaches start at the back of the head. It does not replace migraine-specific treatment when that is what is needed.
How many times can you have an occipital nerve block?
There is no set number, and no pre-booked series. Whether a block is repeated depends on how you respond to it. When relief lasts well beyond the anesthetic, for weeks or months, that is a good sign the block is worth repeating. When relief lasts only hours and the pain returns, the upper cervical joints are usually the real source. Those joints are worth blocking instead.
What should I avoid after an occipital nerve block?
Avoid pressing on the injection site for the rest of the day, because the area has many blood vessels and bruises easily. You do not need to plan for sedation, and most patients do not need a driver. Expect the back of your scalp to feel numb for several hours. Pay attention to how fast your pain changes, because a fast response confirms the diagnosis.
Can an occipital nerve block go wrong?
It is a superficial injection with low risk. Numbness over the back of the scalp for several hours is expected, and bruising at the site is common. A brief spell of dizziness is rare. If steroid is used, a small patch of thin skin or color change at the site is possible. Short-lived relief is not a failure. It tells us the upper cervical joints are the likely source.
Sources
- Velásquez-Rimachi V et al. Greater occipital nerve block for chronic migraine patients: A meta-analysis. Acta neurologica Scandinavica, 2022. PubMed 35726455
- Atraszkiewicz D et al. Greater occipital nerve block for the treatment of migraine: An umbrella review, systematic review, and meta-analysis. Cephalalgia : an international journal of headache, 2025. PubMed 41329694
- Sabet H et al. Ultrasound-guided greater occipital nerve block for chronic migraine: a systematic review and meta-analysis. Head & face medicine, 2025. PubMed 41287059
- Lefel N et al. 11. Cervicogenic headache and occipital neuralgia. Pain practice : the official journal of World Institute of Pain, 2025. PubMed 39219023
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