Blocking the Greater Occipital Nerve: Utility in Headache Management

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.

New and Emerging Treatments for Migraine

“…The greater occipital nerve has sensory fibres originating mainly form the C2 segment of the spinal cord [14]. The effectiveness of GONBs probably arises as a result of its close proximity to the trigeminal afferents [15]. Several techniques to perform occipital nerve blocks exist, and they all appear effective [15].…”

“…The effectiveness of GONBs probably arises as a result of its close proximity to the trigeminal afferents [15]. Several techniques to perform occipital nerve blocks exist, and they all appear effective [15]. However, there is a lack of controlled trials to assess its therapeutic benefits in treating migraines; most of them being small and uncontrolled [16,17].…”

“…Over the past few years, there has been renewed interest in GNOB. However, despite the fact that it is generally safe, potential side effects such as dizziness, light-headedness and nausea, and rarely cardiac arrhythmias and hypersensitivity reactions, are some limitations to its use [15]. Also, the invasive nature of the procedure makes it less acceptable to patients as a first-line treatment.…”

Scalp Block for Burr Holle Evacuation of Subdural Hematoma: A Series of Seven Patients and Review of the Literature

“…This method was initially preferred in patients with a high risk for general anesthesia; however, it was later introduced into the practice in order to provide hemodynamic control during general anesthesia [1], to perform functional monitoring during surgery without administering general anesthesia [2], and to provide perioperative and postoperative analgesia. The scalp block is indicated in intracranial surgeries and chronic headaches, but it is also preferred in many extracranial procedures [3]. As described by Pinosky et al six nerves were identified by landmarks on each side of the cranium (supratrochlear, supraorbital, zygomaticotemporal, auriculotemporal, lesser occipital, and greater occipital nerves) and subsequently infiltrated with volumes of local anesthetic ranging from 2 to 5mL [1].…”

Coma After Greater Occipital Nerve Blockade in a Patient With Previous Posterior Fossa Surgery

“…1 GON blocks are becoming more and more popular in clinical practice nowadays, although higher quality evidence in terms of efficacy and safety is scarce. 1 GON blocks are becoming more and more popular in clinical practice nowadays, although higher quality evidence in terms of efficacy and safety is scarce.…”