Occipital nerve block

For occipital nerve block inject trigger point(s) if one or more can be identified (there is usually a trigger point near the superior nuchal line). The nerve may also be blocked at the point where it emerges from the dorsal neck muscles.

If the pathology is more proximal (e.g. at C2 spinal ganglion), then block of the ganglion may be required.

(done under fluoroscopy): shave hair below the mastoid process; prep with iodine; infiltrate with local; insert a 20 gauge spinal needle midway between C1 and C2, halfway between the midline and the lateral margin of the dorsal neck muscles. Aim rostrally, the final target is the midpoint of the C1–2 joint on AP fluoro, and almost but not touching the inferior articular process of C1. Infiltrate 1–3 ml of anesthetic and check for analgesia in the C2 distribution.