What is an Occipital Nerve Block (ONB)?

An Occiptal Nerve Block (ONB) is an injection of local anesthetic medication next to the greater and lesser occipital nerves, which are located just beneath the scalp in the back of the head. Since these nerves are superficial, just below the skin. This block does not involve brain surgery. This type of injection blocks both the greater and lesser occipital nerves, and is useful in diagnosing and treating a condition known as occipital neuralgia. When treating occipital neuralgia or various other painful conditions, a steroid medication is added to the local anesthetic medication. The block may be done on either the left or right side of the back of the head, or both as indicated. The goal of this procedure is to relieve or reduce pain in the back of the head in the scalp. If you respond to the first injection, you may require repeat injections. Usually, a series of such injections is needed to treat the problem. Some patients may need two or 3 injections, and others may require more. Response to this type of injection will be individual. However, patients who are treated earlier in the course of their illness, tend to respond better than those who have this treatment after 6 months of experiencing symptoms.

If you do not get relief from the injection, you may not have occipital neuralgia. This means that the pain in the occipital region (in the back or back and side of your head) may not be due to damage or dysfunction of the occipital nerves. If this is the case, your physician may choose to order different testing to identify or diagnose the cause of your pain.

How long does the ONB procedure take?

This procedure takes about 10 minutes.

Will the injection hurt?

The procedure involves inserting a needle through the skin, beneath the scalp and moving the needle in a fan-shaped pattern to block both occipital nerves. Some discomfort may be felt, although each person’s response to any procedure is individual.

What should I expect after the procedure and what are the side effects?

Immediately after the injection, the back of your head may feel warm. You may have a small lump on the back of your head for a few hours to days. In addition, you may notice that your pain may be gone or lessened considerably. An ice pack with a barrier such as a towel between the skin and ice may be used after the procedure is completed to reduce minor swelling. The local anesthetic effect will wear off in a few hours. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted.

What should I do after the procedure?

We recommend patients avoid strenuous activities for a day following the procedure; however, you may perform other normal activities as tolerated. You should be able to return to work the next day. You may experience some soreness at the injection site, and you may use an ice pack with a barrier such as a towel to help relieve this as needed.