What To Know About Nerve Block For Migraine

A nerve block procedure could be a viable pain-relief solution for your migraines.

A nerve block is a numbing substance injected around specific nerves to prevent them from causing pain. It eases different types of pain, including chronic pain caused by migraine headaches.

You might be a candidate for migraine nerve blocks if you experience chronic migraine headaches, tension headaches, or cluster headaches. You might get sharp, stinging, burning, or throbbing pain. You may have tried oral pain relievers but found them ineffective.

A migraine nerve block may contain a steroid anti-inflammatory combined with a local anesthetic. The nerve block is injected at the base of the skull or on the upper eyelid.

Two types of nerve blocks are used to manage migraine pain. These are:

1. Occipital nerve blocks

2. Supraorbital nerve blocks

We’ll explore these two procedures in this article.

What is an occipital nerve block?

An occipital nerve block reduces the severity and frequency of migraine headaches and pain in your neck and the back of your head.

During the procedure, a medical professional will inject a pain reliever and steroid into the greater and lesser occipital nerves.

Occipital nerves are located in the second and third vertebrae of the neck and run up on either side of the head. You may experience headaches starting at the base of the skull when these nerves are inflamed. The pain moves up the sides of your head, reaching your eyes and forehead.

What do occipital nerve blocks treat?

You may have an occipital nerve block to treat the following conditions:

Common migraine

A migraine is an intense headache on one side of the head. They are often accompanied by other symptoms such as nausea, dizziness, mood changes, and sensitivity to sound and light.

Occipital nerves can transmit pain signals that cause migraines, so a nerve block to the occipital nerves mitigates common migraine headaches.

Occipital neuralgia

Occipital neuralgia is a headache that starts at the base of your skull and moves up to your temple, eye, and forehead. Irritation of occipital nerves branching up from the spinal cord causes this type of migraine.

A nerve block of the occipital nerve will stop the headache where it begins at the base of your skull.

Cluster headaches

Cluster headaches are brief but extremely painful headaches that can take place several times a day, with some lasting weeks or months before stopping and reoccurring.

Cluster headaches are relatively uncommon. Fewer than one in 1,000¹ people experience this type of migraine, usually after the age of 20. Statistically, men face cluster headaches more often than women, at a rate of six men to each woman.

An occipital nerve block may offer you effective pain relief for cluster headaches.

Neck arthritis headache

Spondylosis of the cervical facet joints, or neck arthritis, is age-related degeneration of the neck’s spinal disks. Neck arthritis can cause painful headaches in some people.

A nerve block can offer you relief from the headaches associated with spondylosis of the cervical facet joints.

Other uses for occipital nerve blocks 

An occipital nerve block is also useful for diagnosing other medical conditions.

Administering an occipital nerve block can determine whether your pain is related to your occipital nerves or other parts of your spine. This can help your medical team identify other possible health conditions.

How effective are occipital nerve blocks for migraine relief?

Occipital nerve block success rates are generally positive.

In a recent study,² 82% of participants experienced some degree of relief after an occipital nerve block, with 58% seeing significant improvement.

The participants’ age and number of doses were found to impact effectiveness.

61% of participants under 65 had a significant response to treatment. This is compared to 54% of patients aged 65 or older.

74% of patients who underwent two or more GON (greater occipital nerve) blocks had a significant response. This was compared to 36% of patients who underwent just one GON block.

How long do occipital nerve blocks work?

You may experience relief in as little as 15 minutes after the procedure.

The long-term results vary from person to person. Some live pain-free for months, while others only last days before getting another migraine. A second injection may be recommended in these cases; however, you can only receive a limited number of doses.

Risks and side effects of occipital nerve blocks

While a nerve block for migraine relief is a relatively safe and common procedure, it can cause some side effects. However, most clear up on the same day the nerve block is administered.

The most common side effects include:

• Pain where the nerve block was injected

• Infection

• Bleeding

• Dizziness or lightheadedness

• Weakness or numbness 

Occipital nerve block procedure

Minimal preparation is needed for an occipital nerve block. The procedure is simple and only takes a few minutes to complete.

What to expect during the procedure

A clinician will ask you to lie down. They will then clean the skin of the injection site and numb it with anesthesia. A needle with the nerve block is then inserted until it reaches the occipital nerve.

After the injection, the clinician will massage the area to disperse the fluid.

You will feel similar pain to any other common injection.

What to expect after the procedure

After the procedure, take over-the-counter pain medications such as acetaminophen (Tylenol, Panadol, or others) or ibuprofen.

The local anesthesia administered before the injection wears off in a few hours, so you can return to most normal activities on the same day. You should avoid soaking in a bath, pool, or hot tub within 24 hours of the injection.

Although some relief occurs within the same day, you will feel the full impact of the dose after two weeks.

Contact your doctor immediately if you experience any of the following:

• Redness or swelling at the injection site

• Chills or a fever of over 100F

• Worsening headaches or new neck and back pain

• Shortness of breath, chest pain, or a persistent cough

If there are no signs of improvement after two weeks, your doctor may recommend a second nerve block injection. However, this could also suggest your occipital nerves are not causing your pain. In this case, your doctor may make an alternative diagnosis.

You may receive three to four nerve blocks annually for chronic migraines. Receiving more than three injections within six months is uncommon, as it puts you at risk of steroid side effects. If more injections are needed to relieve pain, alternative treatments may be considered, such as:

• Cutting off a nerve

• Releasing pressure from a nerve

• Killing nerve cells with radiofrequency or small poison doses

• Inserting an occipital stimulator

Qualifying for an occipital nerve block procedure

First, speak to a physician about any recurring migraine headaches. Your doctor will evaluate your condition and decide whether you qualify for a nerve block or whether alternative treatment methods are more suitable.

Some people with specific medical conditions should avoid an occipital nerve block procedure. Yore doctor may recommend alternative solutions if you:

• Had recent head surgery

• Take blood-thinning drugs

• Have a heart condition

• Are allergic to anything in the medication used

• Have an infection

• Are diabetic

What is a supraorbital nerve block?

Supraorbital nerves give feeling to your upper eyelids, forehead, and scalp. If damage occurs to these nerves due to infection, trauma, tumor, or constriction, you may experience supraorbital neuralgia or pain above the eyebrow that extends to the scalp.

Other symptoms include pain in the forehead and tenderness in the bone opening below your brow or supraorbital notch.

A supraorbital nerve block is a procedure that involves injecting anesthetic agents, such as lidocaine, tetracaine, and bupivacaine, into the supraorbital nerve located on each upper eye bone.

Swimmers who wear tight goggles sometimes aggravate the supraorbital nerve and cause “swimmers headache.” Their scalp can become painful as a result, and they may complain of “painful hair.”

During treatment, the nerve is accessed by injecting the skin beneath the eyelid.

In addition to treating migraines, a supraorbital nerve block helps remedy other types of pain, including pain associated with:

• Acute herpes zoster

• Closing deep wounds

• Removing damaged tissue from burns

• Neuralgia

• Cluster headaches

• Removing foreign objects from the body

• Recovery after surgery

Supraorbital nerve block procedure

You can sit down for this procedure, but laying down is often more comfortable. Your clinician will sterilize the injection site before carrying out these next steps:

• Assessing where the supraorbital nerve exits the eye socket by finding the foramen, or hole, in the bone

• Injecting the area with the anesthetic agent to raise a bump

• Pressing gauze over the eyelid to prevent swelling

• Inserting the needle into the bump, avoiding piercing the foramen

• Aspirating the syringe to confirm the needle is not inside a blood vessel

• Slowly withdrawing the needle

If the needle is correctly inserted and the injection is done slowly, there should be minimal pain.

How long does a supraorbital nerve block last?

The ongoing effect of this treatment is not the same for everyone. While some people experience temporary relief, others are free from migraine pain for months.

A supraorbital nerve block uses different anesthetic agents. How quickly you feel relief depends on the type. Lidocaine is the fastest, with people experiencing results after approximately 75 minutes. Tetracaine takes about three hours, while bupivacaine takes the longest, at around eight hours.

A report³ detailed the caseof a 38-year-old woman who received a supraorbital nerve block. Her original symptoms included a unilateral headache, persistent pain on the left eyebrow, shooting pain with occasional numbness, and tingling on the eyebrow.

The patient reported no pain immediately after the injection was administered.

After one month of follow-up, she reported only mild pain — a three out of 10 on the VAS (visual analog) scale.

Risks and complications of a supraorbital nerve block

A supraorbital nerve block could provide lasting relief from migraine pain. The procedure is standard, with few people reporting adverse side effects. However, it can cause some risks and complications. These include:

• Infection

• Hematoma

• Nerve damage

• Swollen eyelid

• Allergy to anesthesia 

• Bleeding under the skin

• Systemic toxicity 

Speak to your doctor about your condition and symptoms to decide whether this procedure is suitable for you. Your doctor will consider any other medical conditions you have to evaluate your suitability and reduce risk.

The lowdown

Nerve blocks can be an effective, lasting treatment solution that minimizes pain and stops recurring headaches.

The two common nerve blocks used in migraine relief are occipital and supraorbital. An occipital nerve block is injected at the base of your skull, while a supraorbital nerve block is injected into your supraorbital nerve located on your upper eye bone.

The immediacy of relief and long-lasting benefits vary from person to person. The type of agent used will also affect your results.

If you struggle with chronic migraines and have tried conventional pain relievers without success, nerve blocking may offer the relief you need.