Greater Occipital Nerve Block
Indication: Greater Occipital Neuralgia
Greater occipital nerve block is indicated for occipital neuralgia, commonly seen in patients after whiplash injury, falls on the back of the head and other close head injuries.
Patients are often misdiagnosed as tension headache or migraine. The patients may have continuous headaches in the occipital, parietal and sometimes in the frontal region. The headaches may be increased several times a week and may be accompanied with nausea and vomiting. This condition is easily confused with migraine attacks. Physical examination may find positive tenderness over the greater occipital nerve. Palpitation of the greater occipital nerve often makes the headache worse. While the real migraine patients should have no tenderness over the greater occipital nerve.
The occipital nerve block is an easy interventional procedure to perform.
For the procedure, one can palpate the posterior occipital protuberance, move 1.5-2 cm laterally and feel for occipital artery pulsation and groove, then inject 2-3 ml of 0.5% bupivacaine with 20 mg of triamcinolone down to the bone and fan out.
According to my own data, for patients with occipital neuralgia after whiplash injuries, a greater occipital nerve block may provide immediate headache relief in 90% of patients that lasts for 28 days on average.