Occipital Nerve Blocks

Definition of Occipital Neuralgia

is a term used to describe a cycle of pain-spasm-pain originating from the suboccipital area (base) of the skull that often radiates to the back, front, and side of the head, as well as behind the eyes.

Description of Occipital Neuralgia

The occipital nerves are two pairs of nerves that originate in the area of the second and third vertebrae of the neck. While most people’s nerve roots originate in similar places on the spine, cadaver studies show a wide variety of differences between individuals as to the course of the nerves once they leave the spinal column. Often the nerves follow a curving course that passes through various muscles in the upper back, neck and head.

These nerves supply areas of the skin along the base of the skull and partially behind the ear. While the occipital nerves do not directly connect with structures within the skull itself, they do interconnect with other nerves outside of the skull and form a continuous neural network that can affect any given area through which any of the main nerves or their branch fibers pass.

Causes and Risk Factors of Occipital Neuralgia

It occurs more often in women than men. It can have many causes such as trauma (a direct blow or “whiplash”); spinal column compression; nerve lesions; localized infections or inflammation; blood vessel inflammation; and local tumors.

Commonly, the nerves are inflamed and sensitive because they are trapped within the muscles through which they pass. Muscle spasm and pain are often associated with nerve entrapment, which causes localized pain, spasm and muscle cramping.

Symptoms of Occipital Neuralgia

  • Headaches that are localized or following a “ram’s horn” pattern on the side of the head, often starting in the upper neck or base of the skull. It can be one-sided or onboth sides.
  • Scalp that is tender to the touch, often hypersensitive. Even brushing your hair can be a painful experience.
  • Pain or pressure behind the eyes. Eyes are very sensitive to light especially when the is present.

Treatment of Occipital Neuralgia

Treatment may involve oral medications that are designed to reduce inflammation and spasms, localized therapeutic injections, physical therapy, massage, and heat. Occasionally implanted peripheral nerve stimulators are used for refractory cases.

Occipital Nerve Block

These are simple local anesthetic blocks that can be performed in the doctors office. These are excellent for diagnostic purposes and can often provide profound short term relief of severe headache pain. A small amount of bupivicaine, usually mixed with some triamcinolone, is injected under the skin at the back of the head off to one side. This will usually cause transient numbness of the side of the forehead on which it is injected. If this is accompanied by relief of the headache then a diagnosis of occipital neuralgia is made.