An occipital nerve block (ONB) is an injection used to treat certain types of chronic head pain, including occipital neuralgia, migraines, and cluster headaches. The procedure involves injecting a combination of a local anesthetic and a corticosteroid near the greater and lesser occipital nerves, which are located at the base of the skull. The primary goal is to interrupt pain signals and reduce inflammation surrounding these nerves. This minimally invasive, outpatient procedure is often performed when other conservative treatments have not provided sufficient relief.
What to Expect Immediately After the Procedure
The most immediate sensation following an occipital nerve block is a temporary feeling of numbness, tingling, or heaviness across the scalp and the back of the head. This effect is due to the local anesthetic medication, such as lidocaine or bupivacaine, mixed into the injection. The anesthetic begins working almost instantly to block pain signals from the targeted nerves.
Some individuals may notice a temporary change in their ability to move their neck or slight muscle weakness near the injection site. This is a common side effect of the anesthetic and should resolve quickly, typically within a few hours. A feeling of pressure or mild soreness at the injection point is also normal and can persist for a day or two.
It is possible to experience lightheadedness, dizziness, or a temporary increase in headache intensity immediately following the procedure. These effects are usually short-lived, but you will be monitored in a recovery area for about 30 to 40 minutes to ensure they resolve before you are cleared to leave. The initial pain relief from the local anesthetic will typically wear off within a few hours, sometimes as fast as five to eight hours.
Timeline for Therapeutic Pain Relief
It is important to understand the difference between the immediate relief from the anesthetic and the sustained relief from the steroid component. Once the local anesthetic wears off, your original pain may return, and the injection site may feel sore for a day or two. This temporary return of symptoms can be discouraging, but it does not mean the procedure was unsuccessful.
The corticosteroid medication, which provides the lasting therapeutic effect, takes time to reduce inflammation around the irritated nerves. While the anesthetic offers a quick temporary benefit, the anti-inflammatory action of the steroid generally requires two to seven days to begin working fully. In some cases, the full benefit may not be felt for up to two weeks.
Patients should keep a record of their pain levels during this waiting period to accurately assess the injection’s effectiveness for their provider. The duration of pain relief from the steroid is highly variable among individuals, ranging from several weeks to several months. If the first injection provides significant but temporary relief, subsequent blocks may be recommended when symptoms return.
Activity Restrictions and Post-Procedure Care
For the first 24 hours following the occipital nerve block, you should take it easy and avoid strenuous activities. It is recommended not to drive or operate heavy machinery on the day of the procedure, especially if sedation was given, or if you feel dizzy or lightheaded. Arranging for a ride home is common practice to ensure safety.
You should refrain from heavy lifting or intense exercise for 24 to 48 hours to minimize stress on the injection site. For managing any soreness or discomfort at the back of the head, a wrapped ice pack can be applied intermittently for the first 24 hours. You may safely shower on the same day as the procedure, but it is best to avoid submerging the injection site in a bathtub, pool, or hot tub for three days to reduce the risk of infection.
Over-the-counter pain relievers, such as acetaminophen, can be taken to manage localized injection site pain. If you were advised to stop taking blood thinners before the procedure, you should confirm with your doctor when it is safe to resume those medications. Most patients can return to their normal work and daily routine the day after the procedure.
Signs That Require Immediate Medical Attention
Although an occipital nerve block is considered a safe procedure, be aware of rare signs that may require immediate medical attention. Contact your healthcare provider immediately if you develop signs of an infection at the injection site. These signs include increasing warmth, spreading redness, worsening swelling, or any discharge from the needle entry point.
A fever, particularly one over 100.4 degrees Fahrenheit, or the onset of chills should also be reported promptly. Persistent or severe pain that is significantly worse than your typical headache, or pain that does not improve after the first few days, warrants a call to your doctor. Any new or lasting neurological symptoms, such as persistent numbness or weakness lasting longer than six hours, vision changes, or difficulty breathing, require immediate medical evaluation.