Greater occipital nerve block for headache

Key messages for patients

Please read this information carefully, you and your health professional will sign it to document your consent. Please bring the consent form with you to the hospital on the day of your procedure / treatment.

Please bring with you all of your medications and its packaging (including inhalers, injections, creams, eye drops, patches, insulin and herbal remedies), a current repeat prescription from your GP, any cards about your treatment and any information that you have been given relevant to your care in hospital, such as X-rays or test results.

Take your medications as normal on the day of the procedure unless you have been specifically told not to take a drug or drugs before or on the day by a member of your medical team. If you have diabetes please ask for specific individual advice to be given on your medication at your pre-operative assessment appointment.

Please bring any questions or concerns you have with you to your appointment or contact Dr Anderson’s team via the headache specialist nurses, Precious Bolalin or Cristina Morales, on 01223 216760 if you have any questions or concerns.

After the procedure we will file the consent form in your medical notes and you may take this information leaflet home with you.

Important things you need to know

Patient choice is an important part of your care. You have the right to change your mind at any time, even after you have given consent and the procedure / treatment has started (as long as it is safe and practical to do so).

We will also only carry out the procedure on your consent form unless, in the opinion of the health professional responsible for your care, a further procedure is needed in order to save your life or prevent serious harm to your health. However, there may be procedures you do not wish us to carry out and these can be recorded on the consent form. We are unable to guarantee that a particular person will perform the procedure. However the person undertaking the procedure / treatment will have the relevant experience.

All information we hold about you is stored according to the Data Protection Act 1998.

About greater occipital nerve block

An occipital nerve block is an injection of a local anaesthetic (lidocaine) alone or with steroid (depo-methylprednisolone) around the greater occipital nerve which is one of the big sympathetic nerves which supplies the scalp. This nerve is located on either side of the back of the head and can be blocked on one or both sides to help manage your headache as part of your outpatient treatment.

Intended benefits

In people with chronic or disabling headaches, injecting the greater occipital nerve as part of a headache management plan can provide temporary benefits in approximately two thirds of cases. These benefits may be short-lived, lasting only one to two weeks, but some people can experience considerably longer periods of benefit making this a worthwhile treatment to pursue. The headaches may ease in frequency or severity or stop for a period of time. Unfortunately in about one in three cases the injection does not provide any useful benefit.

In people who have had this injection previously, the benefit can occasionally vary from one occasion to the next but patients who respond well typically continue to do so.

Who will perform my procedure?

This procedure will be performed by the consultant neurologist, specialist registrar or the headache nurse specialist.

Before your procedure

At this clinic, we will ask for details of your medical history and carry out any necessary clinical examinations and investigations. Please ask us any questions about the procedure / treatment, and feel free to discuss any concerns you might have at any time. We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring all your medications and any packaging (if available) with you. Please tell the ward staff about all of the medicines you use. If you wish to take your medication yourself (self-medicate), please ask your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

During the procedure

Prior to carrying out the injection, we will feel around the back of your head to locate the tender spot (if it is present) near where the greater occipital nerve sits which is suitable for injection. Experience has shown that the injection is most helpful when given at the point along the greater occipital nerve which is most tender, so establishing the “right spot” prior to injection gives us the best chance of success. However sometimes the tender spot is not where the nerve is and we would then map out the point to inject using the knowledge of where this nerve sits only. Once you are sitting in the correct position, we will clean the back of your head with an alcohol swab. In a single injection, local anaesthetic with steroid (depo-methylprednisolone) is then injected into the targeted area at the back of your head. Some people report hearing the fluid being injected due to the site of injection, but this is not bothersome to most people. The procedure itself may take a few minutes to complete and we will ask you to apply a little pressure to the area afterwards to minimise bruising.

After the procedure

Eating and drinking

After this procedure you can eat and drink as usual.

Getting about after the procedure

After this procedure you should not have any limitations to your mobility.

Leaving hospital

Generally most people who have had this procedure will be able to leave the hospital after the appointment. As some people may feel dizzy after the procedure, we advise you to wait for 15 to 30 minutes in the outpatient area to ensure you feel okay before going home.

Resuming normal activities including work

Usually you can resume normal activities after leaving the hospital.

Special measures after the procedure

We will give you further information about any special measures you need to take after the procedure / treatment. We will also give you information about things to watch out for that might be early signs of problems (eg infection).

Check-ups and results

Before you leave hospital, we will give you an appointment for a follow-up clinic. At that time, we can check your progress and discuss any further treatment.

Significant, unavoidable or frequently occurring risks of this procedure

Some people can experience dizziness after the injection, which is why we advise you to wait for 15-30 minutes in the outpatient area after the procedure.

Slight aching in the back of the head from the injection site has also been reported. We are injecting a reasonable volume of fluid (3 - 4ml) so it is usual to initially feel a slight bump and bruised sensation as the local anaesthetic wears off. A cool compress or refrigerated wheat sack applied locally may offer some relief.

As with any injection there is a minimal risk of infection, so we will ask you to check the area daily for redness and heat and if you are concerned please see your GP.

On rare occasions, people describe a worsening of the headache, which is usually quite short lived, lasting days, and should be managed as you would your headache state normally.

Less than 1% have experienced a small area of hair loss immediately at the site of injection usually no bigger than a 2 pence coin. This is a risk when steroid is in the injection as it can permanently affect the fat cells which are vital to support the hair follicle.

Alternative procedures or treatments that are available

This procedure is part of a headache management plan and all available treatment options will be discussed with the consultant neurologist at the headache clinic. If your headache has settled or you are experiencing less than 12 headache days per month, there is usually no advantage in proceeding with treatment.

There are several treatments that should be pursued as first line prior to considering greater occipital nerve blocks including beta blockers, tricyclic anti-depressants, topiramate, gabapentin and sodium valproate. Non-oral alternative drug options that may be suitable depending on the severity of your headache condition include acupuncture and you should discuss this option with your doctor.

Greater occipital nerve blocks may be an earlier option if drug options are limited due to pregnancy, cardiac problems, poor tolerability or problems managing medication overuse headaches.

You can decide at any point that this treatment is not for you and can ask us not to go ahead. We would advise that you feel comfortable embarking on the decision to start treatment and at all points will try to ensure you have enough information to make an informed decision.

An alternative to greater occipital nerve blocks remains continuing to explore the medical options listed above.

Information and support

You may additionally find the Migraine Trust website (opens in a new tab) helpful which has reference to this treatment as well as other strategies in dealing with headaches.

Information about important questions on the consent form

Photography, Audio or Visual Recordings

As a leading teaching hospital we take great pride in our research and staff training. We ask for your permission to use images and recordings for your diagnosis and treatment; they will form part of your medical record. We also ask for your permission to use these images for audit and in training medical and other healthcare staff and UK medical students; you do not have to agree and if you prefer not to, this will not affect the care and treatment we provide. We will ask for your separate written permission to use any images or recordings in publications or research.

Students in training

Training doctors and other health professionals is essential to the NHS. Your treatment may provide an important opportunity for such training, where necessary under the careful supervision of a registered professional. You may, however, prefer not to take part in the formal training of medical and other students without this affecting your care and treatment.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and / or specialist one to one care is required.