Occipital Nerve Block


  • Occipital Headache
    • Pain radiates from occiput anteriorly-secondary to compression as nerve exits (fibrosis, muscle spasm etc.)
  • Occipital Neuralgia
    • Pain radiates from the greater occipital nerve, lesser occipital nerve, third occipital nerves, or a combination of the three

Clinical Significance

  • Patients of all ages frequently report  headaches, which is a typical clinical complaint in many medical specialties. The condition is often burdensome, can impair  quality of life for patients, and is linked to a significant socioeconomic burden
  • When treating both acute and persistent headaches, the greater occipital nerve block is a useful therapeutic option. Even for individuals with various comorbidities

Locating the Occipital Nerve

  • Locate Atlas, then Axis
  • C2 bifid spinous process
  • Locate Obliquis Capitis Inferior Muscle
  • Lamina of Axis and Transverse Process of Atlas
  • Greater Occipital nerve hyper echoic above Obliquis Capitis muscle
  • CPT 64405 76942


  • Patient refusal
  • Anesthetic allergy
  • Open skull defect
  • Infection

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and Interesting Articles

  • Austin M, Hinson MR. Occipital Nerve Block. [Updated 2022 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580523/
  • Djavaherian DM, Guthmiller KB. Occipital Neuralgia. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538281/
  • Fernandes L, Randall M, Idrovo LPeripheral nerve blocks for headache disordersPractical Neurology 2021;21:30-35.
  • Mungoven TJ, Henderson LA, Meylakh N. Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives. Front Pain Res (Lausanne). 2021 Aug 25;2:705276. doi: 10.3389/fpain.2021.705276. PMID: 35295486; PMCID: PMC8915760
  • Cesmebasi A, Muhleman MA, Hulsberg P, Gielecki J, Matusz P, Tubbs RS, Loukas M. Occipital neuralgia: anatomic considerations. Clin Anat. 2015 Jan;28(1):101-8. doi: 10.1002/ca.22468. Epub 2014 Sep 22. PMID: 25244129.


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