Treatment information
Understanding your pathway
What is the treatment?
An occipital nerve block places local anaesthetic, sometimes with steroid, near nerves supplying the back of the scalp. It may be discussed for selected headache or occipital pain presentations. It is not a substitute for identifying the headache type or for assessing a new or unusual headache. [1][2]
Who may be considered?
Selection depends on the pattern of pain and the clinical assessment. A clinician considers previous treatments, relevant neck findings and whether a block has a useful role in the overall headache plan. Headaches with warning signs require appropriate investigation rather than being treated automatically with a nerve injection. [1][2]
Assessment, preparation and consent
Before deciding, discuss your diagnosis, previous treatment, medicines and relevant health conditions. Tell the clinician about allergies, infection, blood-thinning medicines, diabetes and possible pregnancy. Do not stop prescribed medicines yourself. Ask what alternatives are available, including not having a procedure, and allow time to consider the benefits, uncertainty and risks that matter to you. [3]
What happens during treatment?
The planned nerve and side are identified and the skin is cleaned before medication is injected near the target. The technique and medication vary. Record the original headache pattern and a meaningful goal before treatment so a short-lived anaesthetic effect can be distinguished from a useful longer-term change. [1][2]
Risks and safety considerations
Injection-site soreness, bruising, bleeding, infection and allergy can occur. Steroid may produce local skin or hair changes. Altered scalp sensation or a temporary increase in pain is possible. Discuss medication-specific and anatomical risks, particularly if you have a bleeding condition or take blood-thinning medicines. [1][2]
Recovery and when to seek help
Follow the written instructions for transport, supervision, medicines, activity and driving. Recovery depends on the treatment and your health, so a fixed return-to-work date cannot be promised. Ask who to contact outside clinic hours. Seek urgent assessment for fever with worsening pain, new weakness or other unexpected neurological symptoms. Call 000 for breathing difficulty, collapse or another medical emergency. [4][3]
Expected benefit and limitations
A response may be absent or temporary and does not by itself prove that all headache symptoms arise from the occipital nerve. Continue the agreed headache-management plan and review headache frequency and function. Repeating a block should depend on its actual value and risks rather than a predetermined course. [1][2]
Follow-up and rehabilitation
Before treatment, choose a practical goal such as walking, sleep or a daily task. Record changes in that activity, pain and any adverse effects, then discuss them at follow-up. Ask what degree of change would justify further treatment and what would lead to stopping or changing the plan. Rehabilitation and self-management may remain part of care even if symptoms improve. [3][5]
Questions to bring to your appointment
Ask which structure is being targeted, why this approach is being considered and how strong the evidence is for your diagnosis. Clarify costs, the planned review date and any practical help you may need at home. Bring previous reports and your medicine list so the discussion can address your circumstances rather than a generic treatment pathway.
Sources and further reading
Sources support the statements cited above. Overseas guidance may describe different services or eligibility rules. A procedure leaflet explains a technique and its risks; it does not establish that the treatment is effective for every condition.
- Occipital nerve block — The Dudley Group NHS Foundation Trust
- Headaches in over 12s: diagnosis and management — NICE
- Procedures in pain medicine clinical care standard — Faculty of Pain Medicine, ANZCA
- Dorsal root ganglion / nerve root block / transforaminal injection — Hull University Teaching Hospitals NHS Trust
- Options for chronic pain management — Healthdirect Australia