This block
was used extensively for the treatment of occipital muscle tension headaches
and can affect temporary relief. However, with refractory chronic
headaches, it is rarely curative, and biofeedback has now more or less replaced
this technique as an ongoing means of controlling recurrent tension headaches.
Nonetheless, the block can still be used for crisis intervention, assuming this
is not counterproductive to long-term management goals, which usually aim at
decreasing the patient's reliance on medical technology.
The greater occipital nerve is located just above the neck on either
side of the back of the head. It is a superficial nerve lying just
beneath the skin.
The greater
occipital nerve is the branch of the cervical plexus most frequently
anesthetized. This nerve is located approximately halfway between the
mastoid process and the greater occipital protuberance at the crest of the
occipital bone, and can be identified by palpating the pulsations of the
occipital artery adjacent to it at this site.
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There is no initial preparation by the patient.
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You will be asked to read and sign a consent form before
the block is done.
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The doctor will clean the area with alcohol and slowly
inject the medication through a very small needle. The medications used
are a combination of anesthetic (numbing) medication and a steroid medication.
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Bring someone to drive you home.
The use of anesthetics and steroids reduces the tension and/or
inflammation, thus decreasing the pain associated with the headache or
myofascial pain.
A short 2-cm
needle is inserted halfway between the mastoid process and the greater
occipital protuberance. An injection of 3 ml to 5 ml local anesthetic at
this site will yield analgesia of the central occipital area of the scalp up to
the vertex. The block can be done bilaterally to produce bilateral
analgesia.
This is a
very simple and easily accomplished procedure. If the block is performed cephalad
to the insertion of the cervical paraspinal musculature into the occipital
crest, the bony endpoint of the cranium prohibits further progress of the
needle. Complications include: Seizures,
dizziness, numbness at base of skull, nausea, hematoma, or swelling at puncture
site. These complications are rare; however, there are experienced doctors and
nurses available to assist with these complications. About the only
significant complication is accidental intravascular injection of the drug into
the occipital artery or vein which, given the small quantities of drug needed
for this block, is unlikely to cause much damage.
You may feel numbness in the back and top of your head. The pain
of the headache should decrease and/or resolve.