Nerve block: occipital - Revision history

Danbot: Danbot moved page Nerve Block: Occipital to Nerve block: occipital without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

2026-03-22T05:33:14Z

Danbot moved page Nerve Block: Occipital to Nerve block: occipital without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

← Older revision	Revision as of 05:33, 22 March 2026
(No difference)

Blsimpso at 14:50, 29 June 2021

2021-06-29T14:50:03Z

← Older revision		Revision as of 14:50, 29 June 2021
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	*[[Headache]]		*[[Headache]]
	*[[Migraine_headache\|Migraine]]		*[[Migraine_headache\|Migraine]]

			==External Links==

			===Videos===
			{{#widget:YouTube\|id=6Dj5zYbvLxo}}


	==References==		==References==

Rossdonaldson1 at 23:52, 28 January 2020

2020-01-28T23:52:33Z

← Older revision		Revision as of 23:52, 28 January 2020
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	*Local anesthetic		*Local anesthetic
	**40mg of methylprednisolone or triamcinolone may be mixed with the local anesthetic<ref name="Brock">Brock G. The occasional greater occipital nerve block. Can J Rural Med. 2014 Fall;19(4):152-5.</ref>, but efficacy has not been proven.		**40mg of methylprednisolone or triamcinolone may be mixed with the local anesthetic<ref name="Brock">Brock G. The occasional greater occipital nerve block. Can J Rural Med. 2014 Fall;19(4):152-5.</ref>, but efficacy has not been proven.

	~~{{Maximum doses of anesthetic agents}}~~

	==Procedure==		==Procedure==
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	*Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />		*Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />
	*Repeat on contralateral side, if indicated.		*Repeat on contralateral side, if indicated.

			{{Maximum doses of anesthetic agents}}

	==Complications==		==Complications==

Rossdonaldson1: /* Procedure */

2020-01-28T23:52:04Z

Procedure

← Older revision		Revision as of 23:52, 28 January 2020
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	*Aspirate to ensure not in vessel.		*Aspirate to ensure not in vessel.
	*Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />		*Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />
	**Typically, a local anesthetic such as [[lidocaine]] (1-2%) or[[ bupivacaine]] (0.5%) (or a combination of the two) is injected. Lidocaine has a quicker onset, while bupivacaine has a longer lasting effect.
	*Repeat on contralateral side, if indicated.		*Repeat on contralateral side, if indicated.

Rossdonaldson1 at 23:51, 28 January 2020

2020-01-28T23:51:45Z

← Older revision		Revision as of 23:51, 28 January 2020
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	===Background===		===Background===
	[[File:Gray800.png\|thumb\|Posterior primary divisions of the upper three cervical nerves. (Great occipital nerve labeled at center top.)]]		[[File:Gray800.png\|thumb\|Posterior primary divisions of the upper three cervical nerves. (Great occipital nerve labeled at center top.)]]
			[[File:Gray790.png\|thumb\|Lateral view (greater occipital nerve posterior)]]
	*Therapeutic and diagnostic for occipital neuralgia		*Therapeutic and diagnostic for occipital neuralgia
	*Nerve is between ~8-18 mm deep<ref>M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.</ref>		*Nerve is between ~8-18 mm deep<ref>M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.</ref>

Rossdonaldson1: /* Background */

2020-01-28T23:50:36Z

Background

← Older revision		Revision as of 23:50, 28 January 2020
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	===Background===		===Background===
			[[File:Gray800.png\|thumb\|Posterior primary divisions of the upper three cervical nerves. (Great occipital nerve labeled at center top.)]]
	*Therapeutic and diagnostic for occipital neuralgia		*Therapeutic and diagnostic for occipital neuralgia
	*Nerve is between ~8-18 mm deep<ref>M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.</ref>		*Nerve is between ~8-18 mm deep<ref>M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.</ref>

Rossdonaldson1: /* Procedure */

2020-01-28T23:48:41Z

Procedure

← Older revision		Revision as of 23:48, 28 January 2020
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	*Aspirate to ensure not in vessel.		*Aspirate to ensure not in vessel.
	*Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />		*Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />
			**Typically, a local anesthetic such as [[lidocaine]] (1-2%) or[[ bupivacaine]] (0.5%) (or a combination of the two) is injected. Lidocaine has a quicker onset, while bupivacaine has a longer lasting effect.
	*Repeat on contralateral side, if indicated.		*Repeat on contralateral side, if indicated.


	**Typically, a local anesthetic such as lidocaine (1-2%) or bupivacaine (0.5%) (or a combination of the two) is injected. Lidocaine has a quicker onset, while bupivacaine has a longer lasting effect. Total volume injected is 2-4cc per nerve block.
	**Identify the location of the greater occipital nerve via one of 3 methods:
	**Palpate the occipital artery pulse about 2cm lateral to the occipital protuberance. The greater occipital nerve is just medial to the occipital artery
	**Alternatively, palpate the occipital protuberance and the mastoid process (on side of interest). Measure 1/3 the distance between the two points starting from the occipital protuberance. Stay just superior to the superior nuchal line to remain over the cranium.
	**Alternatively, identify the point of maximal tenderness in the general region as defined above that may elicit paresthesia in the occipital nerve distribution when palpated
	**Clean the site of injection. Using a 23-25G needle, insert the needle at a 90-degree angle toward the occiput until a bony endpoint is obtained. Aspirate to avoid intravascular injection and to prevent injection into CSF. Inject 1cc at the GON, 1cc medial to the nerve, and 1cc lateral to the nerve.


	==Complications==		==Complications==

Rossdonaldson1 at 23:47, 28 January 2020

2020-01-28T23:47:24Z

@@ Line 33: / Line 33: @@
 *Inject ~1-3 mL of local anesthetic. (may inject small amount medial and lateral to nerve to ensure adequate block)<ref name="Brock" />
 *Repeat on contralateral side, if indicated.
 ==Complications==
@@ Line 54: / Line 63: @@
 [[Category:Procedures]]
 [[Category:Neurology]]

Rossdonaldson1: /* Indications */

2020-01-28T23:46:46Z

Indications

← Older revision		Revision as of 23:46, 28 January 2020
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	*[[Migraine]] refractory to conservative treatment		*[[Migraine]] refractory to conservative treatment
	*[[Post-lumbar puncture headache]] refractory to conservative treatment		*[[Post-lumbar puncture headache]] refractory to conservative treatment
	**Refractory occipital migraine, cluster headache, occipital neuralgia, cervicogenic headache, or migraine with occipital nerve irritation or tenderness <ref>https://www.nuemblog.com/blog/occipital-nerve-block</ref>		*Cluster headache, occipital neuralgia, cervicogenic headache, or migraine with occipital nerve irritation or tenderness <ref>https://www.nuemblog.com/blog/occipital-nerve-block</ref>

	==Contraindications==		==Contraindications==

Rossdonaldson1 at 23:46, 28 January 2020

2020-01-28T23:46:17Z

← Older revision		Revision as of 23:46, 28 January 2020
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	*[[Migraine]] refractory to conservative treatment		*[[Migraine]] refractory to conservative treatment
	*[[Post-lumbar puncture headache]] refractory to conservative treatment		*[[Post-lumbar puncture headache]] refractory to conservative treatment
			**Refractory occipital migraine, cluster headache, occipital neuralgia, cervicogenic headache, or migraine with occipital nerve irritation or tenderness <ref>https://www.nuemblog.com/blog/occipital-nerve-block</ref>

	==Contraindications==		==Contraindications==
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	[[Category:Neurology]]		[[Category:Neurology]]

	**For refractory occipital migraine, cluster headache, occipital neuralgia, cervicogenic headache, or migraine with occipital nerve irritation or tenderness <ref>https://www.nuemblog.com/blog/occipital-nerve-block</ref>
	**Typically, a local anesthetic such as lidocaine (1-2%) or bupivacaine (0.5%) (or a combination of the two) is injected. Lidocaine has a quicker onset, while bupivacaine has a longer lasting effect. Total volume injected is 2-4cc per nerve block.		**Typically, a local anesthetic such as lidocaine (1-2%) or bupivacaine (0.5%) (or a combination of the two) is injected. Lidocaine has a quicker onset, while bupivacaine has a longer lasting effect. Total volume injected is 2-4cc per nerve block.
	**Identify the location of the greater occipital nerve via one of 3 methods:		**Identify the location of the greater occipital nerve via one of 3 methods: