Greater Occipital Nerve Blocks for Occipital Neuralgia
What is Occipital Neuralgia?
The Occiput is the area on the back of your head where you have a bumpy ridge. Just off the midline are two small nerves called the Greater Occipital Nerve. These nerves can become inflamed if there is spasm of nearby muscles which can lead to chronic headaches that emanate from the back of the head. The occipital nerves can also be irritated from their original pain generation found at the upper and middle Cervical Facet Joints (neck joints).
How can you treat Occipital Neuralgia?
First, a patient needs to be thoroughly evaluated by a well-trained pain physician. This evaluation will include a thorough description of your pain symptoms, a physical examination to find out your pain generator, and a review of imaging studies to confirm your diagnosis.
If Occipital Neuralgia is suspected we may attack the pain from a variety of directions. Non-interventional treatments could include medications like non-steroidal anti-inflammatory drugs (NSAIDS), neuropathic agents like Gabapentin (Neurontin) or Pregabalin (Lyrica), or muscle relaxants.
Interventional treatments for Occipital Neuralgia include Greater Occipital Nerve Blocks or Cervical Facet Joint Injections.
How do you perform the injections?
If the pain is isolated to the back of the head without much involvement of the neck, we will likely start with a Greater Occipital Nerve Block. This injection is performed in the comfort of a chair in the office with an injection of a corticosteroid and local anesthetic through a small gauge needle. The local anesthetic may start helping the day of the injection. The corticosteroid can take up to 5 days to start to take effect. If you have some injection site pain, you may use ice to help reduce pain. Do not use heat until 24 hours after the injection. Our goal with a Greater Occipital Nerve Block is to get several months of pain relief. If you do gain this desired result, then the injection can be repeated when symptoms flare up.
If there is evidence that the Cervical Facet Joints (Neck Joint Arthritis) are the cause of the headaches on the back of the head, then we will have the patient come in for some test injections to confirm that this is the pain generator.
The test injections are done by administering a local anesthetic to numb the small nerve that supplies the pain to the Cervical Facet Joint (Medial Branch Nerve). The local anesthetic will numb this nerve for 2-24 hours. You will be asked to fill out a pain diary that records your pain during this test period. We will also ask you to let us know if you were able to do your normal activities with less pain or for longer periods of time. We want to see if we can help restore function with these injection(s).
Our goal is to get at least 50% of your pain relieved during this test period. We are not as concerned with the length or amount of time of the pain relief. We are most concerned with the amount or relief, or the improvement in your function. If this amount is satisfactory then you are a candidate to have a Radiofrequency Ablation which can help with longer lasting pain relief (6-24 months).
Are there things I should look for after having this procedure?
Of course, you can call our office for any question you might have. However, there are certain “red flag” warnings that you should call us about, or if after hours you should go to your nearest ER. These “red flag” warnings include severe or worsening pain, fever over 101 degrees, new or worsening weakness, or injection site redness or drainage.