Migraine headaches cause severe throbbing pain or a pulsing sensation, typically on just one side of the head. and is often accompanied by nausea, vomiting, and light and sound sensitivity. It can be very difficult to manage. When medical treatment fails to control it, interventional treatment options need to be considered for the desired relief. An occipital nerve block is one such option.
Occipital nerve blockade is an injection of a steroid or other medication around the greater and lesser occipital nerves on the back of the head just above the neck area.
It reduces the inflammation and swelling of tissue around the occipital nerves, which in turn reduce pain and swelling caused by inflammation. It can be effective in relieving tension headaches and migraine headaches.
The procedure is usually carried out without any sedation and is done with the patient seated or lying down. The skin cleaned with antiseptic solution and then the injection is carried out. The injection itself takes only a few minutes and consists of a local anesthetic and a steroid medication, which are injected through the skin into the deeper tissues of the posterior neck. There is some pain involved, but the local anesthetic helps by numbing the injected area.
Immediately after the injection, the pain quickly subsides but the soreness persists for a day or two. Lasting pain relief typically starts third day onward. The injections can be repeated about one week apart only if the patient persists. One should not get more three occipital nerve blocks with a six-month period, as giving more injections could increase the likelihood of side effects from the steroids. It is important to note that these nerve blocks will not help if the occipital nerves are not be suspected to be involved.
The procedure is generally safe. Some of the side effect in addition to local pain, include infection, bleeding, worsening of symptoms, but these are uncommon.
If you have allergies to the injected medications, if you are on blood thinners, or if you have an active infection, you should not have an occipital nerve block.
What to consider
A few important things to consider before choosing nerve block treatment for stubborn migraine include its efficacy, how long does its effect lasts; and whether it will be covered by insurance.
Studies have shown that the addition of steroids to a greater occipital nerve block does not favorably impact migraine treatment. Greater occipital nerve block for an acute migraine headache can provide immediate relief and sometimes for a sustained period of time.
As far as insurance coverage goes, if you are going to an office for this treatment, these are usually covered, but if it is an emergent case in the ED, the procedure may not be immediately covered.