Occipital nerve blocks in the treatment of headaches: safety and efficacy

J Emerg Med. 2015 Jan;48(1):115-29. doi: 10.1016/j.jemermed.2014.09.007. Epub 2014 Oct 18.


Background: Considering current limitations in known treatment options and the significant disability associated with headache disorders, investigation of additional options is needed. Although occipital nerve blocks (ONBs) are currently being utilized frequently in specialty settings, the potential role of ONBs as an alternative to opioids for the management of acute headache episodes in primary and emergency care settings is not yet understood.

Objective: Our aim was to conduct a systematic literature review of the available evidence regarding the use of ONBs for the management of acute headaches, and then determine its potential for use in the emergency care setting. Techniques, medication selection, adverse reactions, frequency of use, candidates, and measures that can help improve safety were reviewed in order to better evaluate the usefulness of this tool in emergency care.

Discussion: Occipital nerve blocks are technically simple procedures that are highly successful in providing dramatic pain relief results. They are also a relatively safe and beneficial alternative to other headache treatment options. Case reports and research have demonstrated that ONBs can be performed safely in outpatient settings. However, due to the paucity of literature on the use of ONBs in emergency care settings, it can only be speculated that the same outcomes can be achieved.

Conclusions: Interest in the use of ONBs in acute care settings is increasing. Current evidence supports that ONBs can be delivered safely in an outpatient setting by providers who have been trained in and have practiced this procedure. Although additional research is needed, current evidence supports that ONBs can be useful in treating acute headaches in an emergency care setting.

Keywords: efficacy; headache; occipital nerve block; safety; technique.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Emergency Medicine
  • Headache / therapy*
  • Humans
  • Nerve Block* / adverse effects
  • Nerve Block* / methods
  • Spinal Nerves*