Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 5/2010

01-10-2010

Blocking the Greater Occipital Nerve: Utility in Headache Management

Author: William B. Young

Published in: Current Pain and Headache Reports | Issue 5/2010

Login to get access

Abstract

Occipital nerve block has been part of headache medicine for more than half a century, with injection techniques and solutions varying greatly. Most studies have been case series and many show benefit for patients with migraine, cluster headache, and postconcussive headache. A double-blind, controlled trial of cluster headache has demonstrated that injectable steroids with local anesthetics benefit cluster headache patients. A double-blind, controlled trial of nerve blocks in occipital neuralgia, which may have actually been chronic migraine, was positive.
Literature
1.
Wolff HG, ed: Wolff's Headache and Other Head Pain, edn 1. New York: Oxford University Press; 1948.
2.
Bogduk N, Govind J: Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009, 8:959–968.CrossRefPubMed
3.
Raskin NH: Headache, edn 2. New York: Churchill-Livingstone; 1988.
4.
Peres MF, Stiles MA, Siow HC, et al.: Greater occipital nerve blockade for cluster headache. Cephalalgia 2002, 22:520–522.CrossRefPubMed
5.
Kaniecki RG: Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology 2002, 58(9 Suppl 6):S15–S20.PubMed
6.
Marcus DA, Scharff L, Mercer S, Turk DC: Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache 1999, 39:21–27.CrossRefPubMed
7.
Hagen K, Einarsen C, Zwart JA, et al.: The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway. Eur J Neurol 2002, 9:527–533.CrossRefPubMed
8.
Ashkenazi A, Levin M, Dodick DW: Peripheral procedures: nerve blocks, peripheral neurostimulation and botulinum neurotoxin injections. In Wolff’s Headache and Other Head Pain, edn 8. Edited by Silberstein SD, Lipton RB, Dodick DW. New York: Oxford University Press; 2007:767–792.
9.
Afridi SK, Shields KG, Bhola R, Goadsby PJ: Greater occipital nerve injection in primary headache syndromes: prolonged effects from a single injection. Pain 2006, 122:126–129.CrossRefPubMed
10.
Ashkenazi A, Young WB: The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache 2005, 45:350–354.CrossRefPubMed
11.
Caputi CA, Firetto V: Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache 1997, 37:174–179.CrossRefPubMed
12.
Gale GD, Caputi CA, Firetto V: Therapeutic blockade of the greater occipital and supraorbital nerves in migraine patients. Headache 1998, 38:57.PubMed
13.
Scattoni L, Di Stani F, Villani V, et al.: Great occipital nerve blockade for cluster headache in the emergency department: case report. J Headache Pain 2006, 7:98–100.CrossRefPubMed
14.
Hecht JS: Occipital nerve blocks in postconcussive headaches: a retrospective review and report of ten patients. J Head Trauma Rehabil 2004, 19:58–71.CrossRefPubMed
15.
Young WB, Gangal KS, Aponte RJ, Kaiser RS: Migraine with unilateral motor symptoms: a case-control study. J Neurol Neurosurg Psychiatry 2007, 78:600–604.CrossRefPubMed
16.
Rozen TD: Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007, 47:917–919.CrossRefPubMed
17.
Naja ZM, El-Rajab M, Al-Tannir MA, et al.: Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Pract 2006, 6:89–95.CrossRefPubMed
18.
Inan N, Ceyhan A, Inan L, et al.: C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol 2001, 16:239–243.PubMed
19.
Vincent MB, Luna RA, Scandiuzzi D, Novis SA: Greater occipital nerve blockade in cervicogenic headache. Arq Neuropsiquiatr 1998, 56:720–725.PubMed
20.
Anthony M: Cervicogenic headache: prevalence and response to local steroid therapy. Clin Exp Rheumatol 2000, 18(2 Suppl 19):S59–S64.PubMed
21.
Naja ZM, El-Rajab M, Al-Tannir MA, et al.: Repetitive occipital nerve blockade for cervicogenic headache: expanded case report of 47 adults. Pain Pract 2006, 6:278–284.CrossRefPubMed
22.
23.
Piovesan EJ, Werneck LC, Kowacs PA, et al.: Anesthetic blockade of the greater occipital nerve in migraine prophylaxis [in Portuguese]. Arq Neuropsiquiatr 2001, 59:545–551.PubMed
24.
Behmand RA, Tucker T, Guyuron B: Single-site botulinum toxin type A injection for elimination of migraine trigger points. Headache 2003, 43:1085–1089.CrossRefPubMed
25.
Saadah HA, Taylor FB: Sustained headache syndrome associated with tender occipital nerve zones. Headache 1987, 27:201–205.CrossRefPubMed
26.
Gawel MJ, Rothbart PJ: Occipital nerve block in the management of headache and cervical pain. Cephalalgia 1992, 12:9–13.CrossRefPubMed
27.
• Tobin JA, Flitman SS: Occipital nerve blocks: effect of symptomatic medication: overuse and headache type on failure rate. Headache 2009, 49:1479–1485. The authors conclude that medication overuse has a negative impact on outcomes after nerve block.CrossRefPubMed
28.
Ambrosini A, Vandenheede M, Rossi P, et al.: Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005, 118:92–96.CrossRefPubMed
29.
Busch V, Jakob W, Juergens T, et al.: Occipital nerve blockade in chronic cluster headache patients and functional connectivity between trigeminal and occipital nerves. Cephalalgia 2007, 27:1206–1214.CrossRefPubMed
30.
Antonaci F, Pareja JA, Caminero AB, Sjaastad O: Chronic paroxysmal hemicrania and hemicrania continua: anaesthetic blockades of pericranial nerves. Funct Neurol 1997, 12:11–15.PubMed
31.
Mosser SW, Guyuron B, Janis JE, Rohrich RJ: The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches. Plast Reconstr Surg 2004, 113:693–697.CrossRefPubMed
32.
• Ashkenazi A, Matro R, Shaw JW, et al.: Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry 2008, 79:415–417. This study suggests not injecting steroids with local anesthetics for migraine or chronic migraine.CrossRefPubMed
33.
Young WB, Mateos V, Ashkenazi A: Occipital nerve block rapidly eliminates allodynia far from the site of headache: a case report. Cephalalgia 2004, 24:906–907.CrossRefPubMed
34.
Shields KG, Levy MJ, Goadsby PJ: Alopecia and cutaneous atrophy after greater occipital nerve infiltration with corticosteroid. Neurology 2004, 63:2193–2194.PubMed
35.
Schetman D, Hambrick GW Jr, Wilson CE: Cutaneous changes following local injection of triamcinolone. Arch Dermatol 1963, 88:820–828.PubMed
36.
Goldfarb CA, Gelberman RH, McKeon K, et al.: Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg Am 2007, 32:1513–1520.CrossRefPubMed
37.
Goadsby PJ, Zagami AS: Stimulation of the superior sagittal sinus increases metabolic activity and blood flow in certain regions of the brainstem and upper cervical spinal cord of the cat. Brain 1991, 114:1001–1011.CrossRefPubMed
38.
Goadsby PJ, Hoskin KL, Knight YE: Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat. Pain 1997, 73:23–28.CrossRefPubMed
39.
Bartsch T, Goadsby PJ: Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002, 125:1496–1509.CrossRefPubMed
40.
Busch V, Jakob W, Juergens T, et al.: Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalalgia 2006, 26:50–55.CrossRefPubMed
41.
• Young W, Cook B, Malik S, et al.: The first 5 minutes after greater occipital nerve block. Headache 2008, 48:1126–1128. This is a study that demonstrated the rapidity of the response of migraine to lidocaine and that the response is not limited to pain, but also includes associated symptoms.CrossRefPubMed
42.
Mellick LB, McIlrath ST, Mellick GA: Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 417 patients. Headache 2006, 46:1441–1449.CrossRefPubMed
Metadata
Title
Blocking the Greater Occipital Nerve: Utility in Headache Management
Author
William B. Young
Publication date
01-10-2010
Publisher
Current Science Inc.
Published in
Current Pain and Headache Reports / Issue 5/2010
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-010-0130-x

Other articles of this Issue 5/2010

Current Pain and Headache Reports 5/2010 Go to the issue

ReviewPaper

Genetics of Menstrual Migraine: The Epidemiological Evidence

ReviewPaper

Sex Hormones and Pain: The Evidence From Functional Imaging

ReviewPaper

Management of Menstrual Migraine: A Review of Current Abortive and Prophylactic Therapies

Clinical Trial Report

Low-Level Laser Therapy in the Management of Neck Pain

ReviewPaper

Genetics of Menstrual Migraine: The Molecular Evidence

ReviewPaper

Coping Strategies in Chronic Pain