What is an occipital nerve block used for?
An occipital nerve block is used to treat headaches that might arise from occipital neuralgia, tension headaches, and whiplash injuries. It targets the occipital nerves that travel from the spine to the back of the scalp.
How is an occipital nerve block performed?
This minimally invasive day surgery procedure is done with light sedation. It can be performed with a landmark technique but is increasingly done under ultrasound guidance in order to increase the accuracy and success rate of the injection as well as to improve safety.
The back of the scalp and neck is cleaned with antiseptic solution. The occipital nerve and vessels are identified under ultrasound guidance. Local anaesthetic is injected to numb the area and a solution of local anaesthetic and steroid is injected to surround the occipital nerve. The whole procedure should take about 15 minutes.
After the injection, you will be brought to the recovery to rest for about an hour before getting discharged.
Are there any risks with the procedure?
An occipital nerve block is a very safe procedure to undergo. Very rarely is there a risk of bleeding, infection and nerve damage. You may feel dizzy especially if both sides are injected so you must be careful and should be accompanied so as to avoid falls.
What should I do after the procedure?
You should not drive or engage in vigorous activities. It would be best if you were accompanied home. Some pain may recur after a few hours when the local anaesthetic wears off. The pain relief may improve again after about 2 days when the steroid medication starts to take effect. The injection may last a few weeks to 6 months. If the pain relief is not adequate but the injection has given some relief for at least 1-2 weeks, the injection can be repeated or a radiofrequency procedure can be performed.
When should I consider a radiofrequency procedure for the occipital nerve?
A radiofrequency procedure for the occipital nerve can be considered when there has been a good response to the block but the duration of pain relief is inadequate. We can do a radiofrequency ablation or do a pulse radiofrequency procedure. The former destroys the nerve (but the nerve may grow back) whereas the latter only “stuns” the nerve, reducing the nerve sensitivity and tries to modulate it in order for it to be normal again.
In my personal practice, I would perform a pulse radiofrequency of a nerve and will only proceed to do the conventional radiofrequency ablation to destroy the nerve if the pain relief from the pulse radiofrequency procedure is not adequate.