by | Sep 4, 2021


  • Occipital neuralgia
  • Cluster headache
  • Cervicogenic headache
  • Migraine, particularly with occipital nerve irritation or tenderness


  • Infection overlying injection site
  • Allergy to local anesthetic
  • Skull defect


  • 2-10cc of local anesthetic of choice
  • Syringe
  • Cleansing solution
  • 23-25G needle



Position the patient upright


  1. Identify the greater occipital nerve (GON) with any of the following techniques:
    1. Palpate the occipital artery pulse about 2cm lateral to the occipital protuberance. The greater occipital nerve is just medial to the occipital artery.
    2. 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.
    3. Identify the point of maximal tenderness in the general region as defined above that may elicit paresthesia in the occipital nerve distribution when palpated
  2. Clean the site of injection
  3. Insert the needle at a 90° angle toward the occiput until a bony endpoint is obtained
  4. Aspirate to avoid intravascular injection and to prevent injection into CSF
  5. Inject 1cc at the GON, 1cc medial to the nerve, and 1cc lateral to the nerve
  6. The procedure can be repeated on the contralateral side


  1. [Peer-Reviewed, Web Publication] Rogers A, Quarles A. (2020, Jan 13). Occipital Nerve Block. [NUEM Blog. Expert Commentary by Friedman, B]. Retrieved from https://www.nuemblog.com/blog/occipital-nerve-block