• Stephanie G Vanterpool, Robert E Heidel, and Lina R Rejoub.
• Departments of Anesthesiology.
• Clin J Pain. 2020 Apr 1; 36 (4): 289-295.

Background And ObjectivesOccipital nerve block (ONB) is an effective procedure for treating occipital headache pain. However, traditional suboccipital approaches to ONB remain underutilized in acute and chronic settings. An alternative location for ONB is the superior nuchal line, where anatomic studies show a reliable relationship between the occipital artery (OA) and greater occipital nerve. This study evaluated the efficacy and validity of an alternative, single skin insertion, paresthesia-based approach to block both the greater and lesser occipital nerve.Materials And MethodsPatients with a clinical diagnosis of occipital headache were included in this study. External landmarks of the cervical spinous process and ipsilateral tragus were used to predict the location of the OA pulse at the superior nuchal line. Alternative ONB technique was used to block both the greater and lesser occipital nerves using single skin insertion and paresthesia confirmation. Demographic data, preprocedure, and postprocedure pain scores were collected, along with the incidence of procedural outcomes, including OA pulse palpation, paresthesia, and postprocedure numbness.ResultsData were obtained prospectively from 50 patients. Mean pain scores for the sample decreased by 54.64% postprocedure (P<0.001). Greater occipital nerve paresthesia was confirmed 90.0% on the left (95% confidence interval [CI]: 76.3-97.2) and 90.9% on the right side (95% CI: 78.3-97.5). Postprocedure numbness in greater occipital nerve distribution was reported 80.6% on left (95% CI: 64.0-91.8) and 90% on right (95% CI: 76.3-97.2).DiscussionThe results suggest that this alternative approach to ONB effectively reduces occipital headache pain and reliably predicts OA pulse and related greater occipital nerve location as confirmed by paresthesia.

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