Occipital Nerve Blocks and Neurolysis

Occipital neuralgia is currently defined by the International Classification of Headache Disorders, third edition (ICHD-3) as unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp (Headache Classification Committee of the International Headache Society (IHS). Cephalalgia 38:1–211, 2018). The most commonly accepted view on the pathophysiologic cause of occipital neuralgia is chronic entrapment of the greater occipital nerve (GON) by muscles of the posterior neck. Diagnosis is made clinically, based on the patient’s history and physical examinations alignment with ICHD-3 criteria. Management can include reducing muscle tension, improving posture, pharmacological therapy, occipital nerve block, and more invasive procedures such as radiofrequency neurotomy, peripheral nerve stimulation, and open neurotomy. Indication for occipital nerve block is clinical suspicion of occipital neuralgia which may be guided by ICHD-3 diagnostic criteria. Peripheral nerve block of GON and lesser occipital nerve (LON) is both diagnostic and therapeutic.