Nerve Block


Nerve Block

What is a Greater and Lesser Occipital Nerve Block?

Greater and Lesser Occipital Block is an injection of local anesthetic next to the greater and lesser occipital nerves, which are located just beneath the scalp in the back of the head. Since these nerves are outside the
skull, this block does not involve brain surgery.

What is the purpose of it?

The injection blocks both the greater and lesser occipital nerves. This block is useful in diagnosing and treating occipital neuralgia, relieving or reducing pain in the back of the head in the scalp. The block may also be used
to provide surgical anesthesia in the occipital region. The block may be done on either the left or right side of
the back of the head, or both.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivicaine ). When treating occipital neuralgia or other painful conditions, a depot-steroid is added to the local anesthetic.

Will the injection hurt?

The procedure involves inserting a needle through the skin beneath the scalp and moving the needle in a fan-shaped pattern to block both occipital nerves, so some discomfort is involved. However, we may numb the skin in the injection area with a local anesthetic using a very thin needle before inserting the block needle.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia.

How is the injection performed?

It is done while you sit with your head bend forward and your forehead resting on a padded bedside table. You are monitored with an EKG, blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes are also placed on your feet. A small area around the injection site will be shaved of hair.

What should I expect after the injection?

Immediately after the injection the back of your head may feel warm. In addition, you may notice that your pain may be gone or lessened considerably.

What should I do after the procedure?

You should have a ride home. We advise patients to take it easy for a day or so after this procedure. Perform normal activities as you can tolerate them.

Can I go to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common
thing you may feel is soreness in the back of your head at the injection site.

How long will the effects of the medication last?

The local anesthetic wears off in a few hours.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need 2 to 4 and some may need 10 or more. The response
to such injections varies from patient to patient.

Will the Greater and Lesser Occipital Block help me?

If you do not get relief from the injections, you may not have occipital neuralgia. This means that the pain in the occipital region (in the back or back & side of your head) may not be due to damage or dysfunction of the occipital nerves.

It is very difficult to predict if the injection(s) will help you out or not. The patients who are treated earlier during their illness tend to respond better than those who have this treatment after six months of symptoms do. Patients in the advanced stages of disease may not respond adequately. This is not a pertinent but it may lessen the
pain for several days, weeks, or months.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The most common side effect is pain — which is temporary. Since the scalp is highly vascular, having many tiny blood vessels near the surface of the skin, bleeding is common and to reduce it an ice pack
may be used after the procedure.

The other risk involves bleeding, infections, spinal block and injection into blood vessels and surrounding nerves. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin, Plavix, or Heparin), if you have an active infection going on near the injection site, or if you are, or could be pregnant you should not have the injection.

Prepare for a Procedure
Greater Occipital Nerve Block

A safe, relatively simple and temporary procedure, occipital nerve blocks are performed at the COLUMBIA CLINIC to help diagnose and treat certain kinds of head pain.

What is an occipital nerve block?

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, 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 nearly 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"-made numb with an injection of medication-to relieve pain.

Why do I need one?
The best candidates for greater occipital nerve block are those patients with one-sided head pain that occurs predominately at the back of the head. Patients with the "nerve-like" shooting, zapping, stinging, or burning pain of occipital neuralgia generally respond best. We have also had some degree of temporary success for patients with migraines, cluster headaches, and a variety of other painful conditions, particularly when the scalp becomes tender, indicating that the nerve is inflamed.

How do I prepare?
There are no special steps you will need to take to prepare for the procedure.

What happens on the day of my procedure?
You will be asked to lie down on an examination table. The scalp at the back of the head will be cleaned with alcohol, and your provider will locate the site of the nerve feel (it is often quite tender). Using a thin needle, about a teaspoonful of a mixture of local anesthetic and steroids are injected into the scalp in the area of the "trunk" of the nerve. If the injection has been properly located, the scalp on the injected side will quickly go numb, often relieving pain within minutes. You will be asked to note how this numbness affects your symptoms. A more permanent procedure on the nerve would be expected to have a similar effect. This numbness will wear off over several hours. If there is a significant amount of inflammation present, the steroids may begin to work in the next few days to help bring your pain under control for longer, sometimes weeks or months.

What happens after my procedure?
For patients achieving good results with these temporary nerve blocks, there are a variety of other more permanent pain-relieving procedures that can be performed by our surgeons or Anesthesia Pain Clinic, including cutting the nerve, decompressing the nerve, or damaging it with small doses of a toxin or with a radio-frequency energy probe.

An occipital nerve stimulator (basically a nerve pacemaker) can also be helpful. If you do well with the temporary blocks, your provider will discuss the pros and cons of these options with you.

Are there any complications from the procedure?
Complications of greater occipital nerve blocks are very rare and almost never serious. Bleeding, infection, pain, and allergic or other adverse reaction to the anesthetic or steroid are possible. A few patients briefly feel faint. Sometimes a small area of the scalp at the site of the injection will thin out and lose hair. The needle stays outside the skull, so there is no chance of a spinal fluid leak, meningitis, or brain or spinal cord injury. The nerve does not connect to any muscles, so weakness or change in facial expression will not occur.