Greater occipital nerve block for headache

Key messages for patients

Please read this information carefully, you and your health professional will sign it to document your consent. Please bring the consent form with you to the hospital on the day of your procedure / treatment.

Please bring with you all of your medications and its packaging (including inhalers, injections, creams, eye drops, patches, insulin and herbal remedies), a current repeat prescription from your GP, any cards about your treatment and any information that you have been given relevant to your care in hospital, such as X-rays or test results.

Take your medications as normal on the day of the procedure unless you have been specifically told not to take a drug or drugs before or on the day by a member of your medical team. If you have diabetes please ask for specific individual advice to be given on your medication at your pre-operative assessment appointment.

Please bring any questions or concerns you have with you to your appointment or contact Dr Anderson’s team via the headache specialist nurses, Precious Bolalin or Cristina Morales, on 01223 216760 if you have any questions or concerns.

After the procedure we will file the consent form in your medical notes and you may take this information leaflet home with you.

Important things you need to know

Patient choice is an important part of your care. You have the right to change your mind at any time, even after you have given consent and the procedure / treatment has started (as long as it is safe and practical to do so).

We will also only carry out the procedure on your consent form unless, in the opinion of the health professional responsible for your care, a further procedure is needed in order to save your life or prevent serious harm to your health. However, there may be procedures you do not wish us to carry out and these can be recorded on the consent form. We are unable to guarantee that a particular person will perform the procedure. However the person undertaking the procedure / treatment will have the relevant experience.

All information we hold about you is stored according to the Data Protection Act 1998.

About greater occipital nerve block

An occipital nerve block is an injection of a local anaesthetic (lidocaine) alone or with steroid (depo-methylprednisolone) around the greater occipital nerve which is one of the big sympathetic nerves which supplies the scalp. This nerve is located on either side of the back of the head and can be blocked on one or both sides to help manage your headache as part of your outpatient treatment.

Intended benefits

In people with chronic or disabling headaches, injection of the greater occipital nerve as part of a headache management plan can provide temporary benefits in approximately two thirds of cases. The benefits may be short-lived, lasting only one to two weeks, however some people can experience a much longer period of improvement, making this a worthwhile treatment option. Headaches may become less frequent or less severe or may stop altogether for a period of time. Unfortunately, in about one in three cases the injection does not provide any useful benefit.

In people who have had this injection previously, the level of benefit can occasionally vary from one treatment to the next, but patients who respond well typically continue to do so. For safety reasons, steroid injections are given no more often than once every three months.

Who will perform my procedure?

This procedure will be performed by the consultant neurologist, specialist registrar or the headache nurse specialist.

Before your procedure

At this clinic, we will ask for details of your medical history and carry out any necessary clinical examinations and investigations. Please ask us any questions about the procedure / treatment, and feel free to discuss any concerns you might have at any time. We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring all your medications and any packaging (if available) with you.

During the procedure

Before the injection, we will feel the back of your head to identify the tender spot (if present) near the greater occipital nerve that is suitable for injection. Experience has shown that the injection is most helpful when given at the point along the nerve which is most tender, so finding the “right spot” beforehand gives the best chance of success.

In some cases, the tender spot may not correspond exactly to the position of the nerve. If this happens we will identify the appropriate site based on our anatomical knowledge of where this nerve is located.

Once you are sitting in the correct position, the skin at the back of your head will be cleaned with an alcohol swab. A single injection of local anaesthetic which may be combined with steroid (depo-methylprednisolone) is then injected into the targeted area

Some people notice a sensation or sound as the fluid being injected due to the location of the injection, but this is usually not uncomfortable. The procedure itself takes only a few minutes to complete. Afterwards, we will ask you to apply gentle pressure to the area to help reduce the risk of bruising

After the procedure

Eating and drinking

After this procedure you can eat and drink as usual.

Getting about after the procedure

After this procedure you should not have any limitations to your mobility.

Leaving hospital

Most people are able to leave the hospital shortly after the procedure. However, as some people may feel dizzy afterwards, we recommend that you remain in the outpatient area for 15 to 30 minutes to ensure you feel well before going home.

Resuming normal activities including work

You can usually return to your normal activities shortly after leaving the hospital.

Special measures after the procedure

We will give you further information about any special measures you need to take after the procedure / treatment. We will also give you information about things to watch out for that might be early signs of problems (eg infection).

Check-ups and results

You will be given an appointment for a follow-up clinic. At this appointment, we will review your response to treatment and your progress and discuss any further treatment if needed.

Significant, unavoidable or frequently occurring risks of this procedure

Some people may experience dizziness during or after the injection. For this reason we advise that you wait in the outpatient area for 15- 30 minutes after the procedure before leaving the hospital.

Mild aching at the injection site at the back of the head has also been reported. As a moderate volume of fluid (3 - 4ml) is injected, it is normal to feel a slight bump and bruised sensation initially, particularly as the local anaesthetic wears off. Applying a cool compress or refrigerated wheat sack to the area may help to relieve discomfort.

As with any injection, there is a small risk of infection. We ask that you to check the area daily for signs of significant redness or warmth. If you have concerns, please contact your GP.

On rare occasions, some people experience a temporary worsening of their headache. This is usually short lived, lasting a few days, and should be managed in the same way as your usual headache state.

Less than 1% of people experience a small area of hair loss immediately at the injection site, usually no bigger than a 2 pence coin. This is a known risk when steroid medication is used, as it can permanently affect the fat cells which are vital to support the hair follicle.

Very rarely, steroid injections can interfere with the body’s own steroid production. The body produces a steroid hormone called cortisol, which is essential for responding to stress or illness. If repeated steroid injections are required, we may arrange an early-morning blood test to ensure that your body is still producing adequate levels of cortisol.

Alternative procedures or treatments that are available

This procedure forms part of a wider headache management plan. All available treatment options will be discussed with the consultant neurologist at the headache clinic. If your headaches have settled, or you are experiencing fewer than 12 headache days per month, there is usually no advantage in proceeding with treatment.

Several treatments are generally recommended as first-line options before considering greater occipital nerve blocks. For migraine these include beta blockers, tricyclic anti-depressants, topiramate, candesartan. For cluster headache these include verapamil, topiramate and gabapentin or pregabalin. . Non-oral treatment options may also be appropriate depending on the severity of your headache condition. These can include treatments such as the injectable CGRP monoclonal antibodies, acupuncture, medical devices that stimulate the nerves through the skin (cefaly device for migraine or the external vagal nerve gammacore device), which you should discuss with your doctor.

Greater occipital nerve blocks may be considered earlier if medication options are limited, for example due to pregnancy, heart conditions, poor tolerance of medications or difficulty managing medication-overuse headaches.

You may decide at any stage that this treatment is not right for you and ask us not to proceed. We want you to feel comfortable with your decision to start treatment, and we will try to ensure you have enough information at all stages to make an informed choice.

An alternative to greater occipital nerve blocks is to continue exploring the medical treatment options listed above

Information and support

You may additionally find the Migraine Trust website (opens in a new tab) helpful which has reference to this treatment as well as other strategies in dealing with headaches.

Information about important questions on the consent form

Photography, Audio or Visual Recordings

As a leading teaching hospital we take great pride in our research and staff training. We ask for your permission to use images and recordings for your diagnosis and treatment; they will form part of your medical record. We also ask for your permission to use these images for audit and in training medical and other healthcare staff and UK medical students; you do not have to agree and if you prefer not to, this will not affect the care and treatment we provide. We will ask for your separate written permission to use any images or recordings in publications or research.

Students in training

Training doctors and other health professionals is essential to the NHS. Your treatment may provide an important opportunity for such training, where necessary under the careful supervision of a registered professional. You may, however, prefer not to take part in the formal training of medical and other students without this affecting your care and treatment.

Privacy and dignity

If you would like a chaperone to be present during the procedure, please let us know and we will try to arrange this.