Touch, pain, or temperature sensations in the scalp must be conveyed to the brain in order for us to feel them. Several nerves accomplish this purpose, and the greater occipital nerve is one of the more important ones. There are two greater occipital nerves, one on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp, supplying feeling, including pain to a good portion of the back and top of the head. They sometimes reach as far forward as the forehead, but do not cover the face or the area near the ears; other nerves supply the feeling to these regions. Sometimes, even though they don’t reach the front of the head, through a mechanism called ‘referred pain’. Irritation of one of the occipital nerves can be also be felt near the eye on the same side.
Like many other nerves, the greater occipital nerves can be blocked or made numb with an injection of medication to relieve pain. Using ultrasound for guidance, injections are made to the back of the head, just above the neck. Pain concentrated at the back of the head, including certain types of tension headaches and migraine headaches, often respond to this treatment. The procedure itself takes just a few minutes. The injected steroid reduces any inflammation and swelling of tissue around the occipital nerves because that inflammation is frequently the root cause of a patient’s head pain.
Discomfort during the procedure should be minimal since the injection site is numbed with a local anesthetic using a very thin needle during the performance of the block.
After the procedure, the patient will rest briefly in the office. Most people can drive themselves home, but should take it easy and not return to work or other taxing activities until the next day. If a patient desires further sedation, that is usually available, although, not necessary and more sedation does increase recovery time. If extra sedation is requested, a second party must then drive the patient home.
Patients are advised to be aware that after the injection, pain may seem to be completely gone, but this is due to the anesthetic and will only last for a few hours. Be prepared as the original pain will likely return in addition to a sore head for a day or two. The good news is that after three to five days, longer-term pain relief is possible.
Patients’ degrees of response vary widely. For those patients who do not have success with the first occipital nerve block, subsequent injections may or may not be advisable. Doctors usually only recommend the procedure when it seems likely that inflamed tissues around the occipital nerves are causing a patient’s pain. The first injection is essentially a test. If a patient experiences at least some degree of relief, that is confirmation that the occipital nerves are the culprit for their pain and more injections will likely help.
Additional nerve blocks are usually performed about a week apart as needed, but most doctors won’t conduct more than three in a six-month period. If pain returns before six months are up, alternate treatments are pursued.
If you are interested in the occipital nerve block procedure, please contact Dr. Adrian C. Dumitru. He is a board certified and fellowship trained pain management specialist. Click here to learn more, or to schedule an appointment please call (713) 461-8555.