Home › Treatments › Occipital nerve blocks and radiofrequency

Occipital nerve blocks and radiofrequency

Occipital nerve blocks target the nerves running from the upper neck over the back of the head. They are used for occipital neuralgia and some cervicogenic headaches, both to confirm the diagnosis and to provide relief.

The greater and lesser occipital nerves arise from the upper cervical spine and supply the back of the head. When irritated, they produce pain at the base of the skull that shoots over the scalp, often with tenderness over one point and altered sensation in the area. This is distinct from migraine, though the two coexist often enough to cause diagnostic confusion.

Assessment first. Not all headache at the back of the head is occipital neuralgia. Migraine, cervicogenic headache arising from upper cervical joints, medication overuse headache and other causes all need to be considered. A block that abolishes the pain supports an occipital source; one that does not redirects the assessment usefully.

The block. Local anaesthetic, sometimes with anti-inflammatory medication, is placed around the nerve. It takes about 15 minutes, is often done with ultrasound guidance, and does not usually require sedation. Relief from the anaesthetic is immediate and lasts hours; any longer effect develops over the following days and varies widely — some people get weeks or months, others little.

Radiofrequency. Where blocks are repeatably positive but the benefit does not last, radiofrequency treatment of the occipital nerves or of the upper cervical medial branches may be considered, depending on where the pain is actually coming from.

Upper cervical joints. Headache frequently originates from the upper cervical facet joints rather than the occipital nerves themselves. Where this is suspected, diagnostic medial branch blocks at those levels are the appropriate test, and radiofrequency neurotomy the potential treatment.

Afterwards. Numbness over the scalp is expected and settles as the anaesthetic wears off. A tender lump at the injection site for a day or two is common.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.