Greater Occipital Nerve Blockade

J Headache Pain. 2006 Apr;7(2):98-100. Epub 2006 Apr 26.

Great occipital nerve blockade for cluster headache in the emergency department: case report.

Pain Center Enzo Borzomati, Policlinico Umberto I, University of Rome La Sapienza, v.le del Policlinico 155, 00185, Roma. lorescat@yahoo.it

A 44-year-old man with a past medical history of episodic cluster headache presented in our ED with complaints of multiple daily cluster headache attacks, with cervico-occipital spreading of pain from May to September 2004. The neurological examination showed no abnormalities as well as brain and spine MRI. Great Occipital Nerve (GON) blockade, with Lidocaine 2% (5 ml) and betamethasone (2 mg), were performed in the right occipital region (ipsilaterally to cluster headache), during attack. GON blockade was effective immediately for the attack and the cluster period resolved after the injection. We suppose that the action of GON blockade may involve the trigemino-cervical complex and we moreover strongly suggest to use GON blockade in emergency departments for cluster headache with cervico-occipital spreading as attack abortive therapy, especially in oxygen and sumatriptan resistant cluster headache attacks, in patients who complaints sumatriptan side-effects or have contraindications to use triptans.

PMID: 16688413

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Pain. 2005 Nov;118(1-2):92-6. Epub 2005 Oct 3.

Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study.

Ambrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F, Schoenen J.

Headache Clinic, INM Neuromed, IRCCS, Via Atinense, 18, I-86077 Pozzilli, Isernia, Italy. anna.ambrosini@neuromed.it

Oral steroids can interrupt bouts of cluster headache (CH) attacks, but recurrence is frequent and may lead to steroid-dependency. Suboccipital steroid injection may be an effective 'single shot' alternative, but no placebo-controlled trial is available. The aim of our study was to assess in a double-blind placebo-controlled trial the preventative effect on CH attacks of an ipsilateral steroid injection in the region of the greater occipital nerve. Sixteen episodic (ECH) and seven chronic (CCH) CH outpatients were included. ECH patients were in a new bout since no more than 1 week. After a one-week run-in period, patients were allocated by randomization to the placebo or verum arms and received on the side of attacks a suboccipital injection of a mixture of long- and rapid-acting betamethasone (n=13; Verum-group) or physiological saline (n=10; Plac-group). Acute treatment was allowed at any time, additional preventative therapy if attacks persisted after 1 week. Three investigators performed the injections, while four others, blinded to group allocation, followed the patients. Follow-up visits were after 1 and 4 weeks, whereafter patients were followed routinely. Eleven Verum-group patients (3 CCH) (85%) became attack-free in the first week after the injection compared to none in the Plac-group (P=0.0001). Among them eight remained attack-free for 4 weeks (P=0.0026). Remission lasted between 4 and 26 months in five patients. A single suboccipital steroid injection completely suppresses attacks in more than 80% of CH patients. This effect is maintained for at least 4 weeks in the majority of them.

PMID: 16202532

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Cephalalgia 2002; 22:520–522. London. ISSN 0333-1024

Greater occipital nerve blockade for cluster headache. 

Peres MFP, Stiles MA, Siow HC, Rozen TD, Young WB & Silberstein SD. 

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat.


We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1+23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block (P<0.003, P=0.003, P<0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache. u Cluster headache, nerve block, occipital nerve


Stephen D. Silberstein MD, FACP, Jefferson Headache Center, Thomas Jefferson University,
Philadelphia, PA, USA. Tel. +1 215 955 2243, fax +1 215 955 6682,
e-mail Stephen.Silberstein@mail.tju.ed Received 22 October 2001, accepted 15 April 2002

Page Last Updated:  11/27/2007