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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.
In brief
- For pain at the base of the skull radiating over the back of the head.
- Distinguishes occipital neuralgia from migraine and neck-driven headache.
- Ultrasound or landmark-guided; takes about 15 minutes.
- Radiofrequency treatment is also available.
- Headache assessment comes first — not all headache is occipital.
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.
Practical information
- Where
- Most procedures are performed as a day case at St John of God Subiaco Hospital, Hollywood Private Hospital, Mount Private Hospital or St John of God Midland Hospital; some smaller procedures are performed in the rooms at Mount Lawley. The setting is confirmed with you at booking.
- Referral
- Required from a GP or specialist — by Healthlink (EDI painmdwa), fax 08 6114 0717 or email. Routine appointments are generally available within two to four weeks.
- Before the day
- Fasting, medication and transport requirements are set out on Before your procedure. If you take blood-thinning medication, or diabetes or weight-loss injections, tell the practice well before the day.
- Costs
- Dr Martin is a no-gap provider for in-hospital procedures with all major health funds, subject to your level of cover. A fee estimate is supplied on booking, prior to your consultation. See Fees and billing.
- Afterwards
- If your procedure is under sedation you cannot drive for 24 hours afterwards — please arrange transport home. Written post-procedure instructions are provided.
- Rural and remote
- Assessment and review can be done by telehealth; the procedure itself is scheduled in Perth.
How to arrange an appointment
A referral from a GP or specialist is required. Referrals are accepted by Healthlink (EDI: painmdwa), fax 08 6114 0717 or email admin@painmedicinewa.com.
Enquiries: 0448 299 260 — Monday 9:00am – 4:00pm, Tuesday to Thursday 8:00am – 4:00pm.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
This page provides general information only and is not a substitute for individual medical advice. Whether a treatment is appropriate for you is a decision made in consultation with your doctor.
Reviewed by Dr Chris Martin, Consultant Pain and Rehabilitation Physician (FFPMANZCA, FAFRM RACP), Pain Medicine WA, Perth. Last reviewed August 2026.In a medical emergency, call 000.