Greater occipital nerve (GON) blocks for headache

A National Migraine Centre factsheet

An effective treatment for many people with cluster headache and migraine

This factsheet was produced by headache doctors and brings together the latest trusted advice and information on GON blocks for migraine.

Greater occipital nerve (GON) blocks have been demonstrated to be effective for most people with migraine, but they are also an important treatment option for those with cluster headache.

The National Migraine Centre provides access to expert clinicians who can provide greater occipital nerve block treatment for headache in the UK. You can find out more and book an appointment here.

What is a greater occipital nerve (GON) block?

A greater occipital nerve block, often referred to as a GON block (or just a nerve block), is an injection of local anaesthetic and steroid around the greater occipital nerve (GON), at the back of the head and top of the neck, designed to reduce the inflammation of tissue and relieve headache.

For many people with chronic or disabling headaches, injecting the GON as part of a headache management plan can relieve pain significantly.

The injection may be beneficial in certain types of headaches, including chronic migraine, frequent migraine, medication overuse headache and chronic daily headache. It’s also notable in being one of the more effective treatments for those with cluster headache.

About two-thirds of people with migraine will benefit from GON block treatment. Benefits can last for up to three months, although some find improvements wane after a few weeks. Headaches may ease in frequency or severity or stop altogether.

Nerve block for migraine and cluster headache

Most primary headaches happen because there is an amplification of pain and other sensory messages in an area of the brainstem called the trigeminal nucleus.

The greater occipital nerve feeds upwards into the trigeminal nucleus. A nerve block reduces traffic in this nerve, so reducing the symptoms of migraine, cluster headache and other primary headache.

Although the injection takes places at the back of the head, an effective treatment will reduce pain at the front of the head too, such as occurs during cluster headache.

The procedure

A nerve block injection for headache only takes a minute or so.

The injection is 2ml of mixed local anaesthetic and steroid that stays at the injection site.

The injection is just behind the ear. It can be performed while sitting in a chair or lying down.

Following the injection

There is often a sensation of numbness in the head, part of the neck or shoulder.

There can be a little bleeding at the site of the injection: this can be stopped by gently pressing tissue or cotton wool over the injection site.

It is best to have someone accompanying you for the first injection but usually there is no reason not to carry on with your daily activities as normal.

What side effects might I get?

It is common to experience a lump at the injection site with an accompanying ‘bruised’ sensation for a few days.

About one in 30 patients experience temporary worsening of their head pain.

In theory, infection of the injection site could occur, although this is not common.

Very rarely, patients can faint, particularly when phobic to injections: these patients should be lying down for the procedure.

Some people can experience hair loss (temporary) or atrophy at the site of injection.

Most people have no, or relatively minor, side effects. This is not a full list of side effects and you should discuss with a headache specialist before proceeding.

How long will it be before I notice any benefit?

Benefits could start quickly, within an hour or so, although it can take up to a week to begin to see an improvement.

How many injections do I need to have?

In some cases, where the benefit is good but short-lived, treatment can be repeated after a month. Otherwise, it can be repeated as often as every two months.

If the injections need to be repeated every two months for a year, it may be better to speak to your headache specialist about considering other treatment options.

Not all treatments work for all patients; if you have two successive greater occipital nerve blocks with insufficient benefit, it’s probably best to try a different treatment.

Who cannot have a nerve block?

You cannot have this nerve block if you are allergic to any of the medications being injected or if you have an active infection near the injection site. Nerve blocks are also unsuitable for those aged under 16. A headache specialist can tell you more about whether or not this procedure could be right for you.

How to get a nerve block for migraine, cluster headache or other primary headache

At the National Migraine Centre, we can provide you with quick and easy access to a clinician who is able to discuss with you GON block treatment. We can also book you a place at a regular procedure clinic, where trained headache specialists offer nerve blocks.

You can find out more about nerve block pricing here or go ahead and request an appointment.

Speak to a leading GP headache specialist or consultant neurologist remotely, from the comfort of your home.

The National Migraine Centre has helped thousands of people like you to take control of headache. Get expert advice with specialist consultations, access the latest treatments and anti-CGRP medications, and book procedures such as Botox and nerve block.

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