Peripheral Nerve Blocks

Peripheral Nerve Blocks

Anyone who experiences persistent, severe headaches, migraines or other types of facial or neck pain knows how much it can hinder a person’s quality of life. Occipital and supraorbital nerve blocks can provide these sufferers with much-needed pain relief. Dr. Sonia Pasi offers both types of nerve blocks to select patients at Advanced Pain Consultants.

A nerve block is a minimally-invasive, outpatient procedure involving an injection of medication into a nerve or a group of nerves which are causing pain. Usually the medication injected is a combination of a local anesthetic (which numbs the treatment area) and a steroid (an anti-inflammatory agent). The medication works by “blocking” or “inhibiting” the nerve’s pain signals to brain and central nervous system, in order to decrease the sufferer’s level of pain.

An occipital nerve block addresses the greater and lesser occipital nerves that are located on the back of the head, just above the neck and at the base of the skull. Dysfunction of the occipital nerves can cause intense headaches at the back of the head, with pain often radiating down into the neck and shoulders. A supraorbital nerve block addresses the supraorbital nerves which can be the cause of pain in and around the forehead, scalp, eyes, orbits and eyebrows. The steroid that is injected reduces the inflammation and swelling of tissue around the nerves, which in turn, reduces pain.


Candidates for an occipital or a supraorbital nerve block are patients with severe, chronic headaches (migraine, tension or cluster). Typically the headache pain is described as shooting, sharp, zapping, stinging, burning or throbbing. Oral analgesics may have been tried, but did not provide sufficient relief from pain.

When the pain arises from the upper back part of the neck or the base of the skull, the occipital nerves are likely to be involved, and if so, an occipital block might be recommended. If the pain seems to emanate from the scalp, forehead or eyes, then the supraorbital nerves may be irritated, which would call for a supraorbital nerve block.

In addition to headaches, occipital nerve blocks can also treat pain associated with:

  • Occipital neuralgia (a neurological condition caused by damaged occipital nerves).
  • Whiplash or other neck or head injury or trauma.
  • Cervical facet joint syndrome (arthritis in the neck).

Patients who are diabetic or taking blood thinning medications, or have an active infection or uncontrolled heart disease, should not have a nerve block or at least postpone it until their overall medical condition has improved.


Both occiptal and supraorbital nerve blocks are performed in-office, and only take a few minutes to do. Sedation is rarely needed. Dr. Pasi starts by applying a numbing solution to the skin over the treatment area. For an occipital nerve block, she will then use a fine, hollow needle to inject a small amount of medication into the scalp, at the rear of head, to treat the affected occipital nerve tissues. If Dr. Pasi is doing a supraorbital nerve block, she will inject the needle into the forehead, just above of the eyebrow, to treat the area around the supraorbital nerves. Once the medication has been injected, the needle will be removed and the skin will be cleansed and bandaged.

The patient may be asked to stay in the office for 20 to 30 minutes to be monitored for any adverse reactions, before being discharged to go home. Some people feel lightheaded for a short time after the injection, so it is important that patients have someone with them to drive them home.


The majority of patients who undergo an occiptal or a suprorbital nerve block experience some level of pain relief as a result. The extent of relief and how long it lasts varies from patient to patient. In general, those who get the treatment after a recent onset of symptoms respond better than people who have had long-term pain.

Many patients report an immediate relief of symptoms following the injection. However, this is usually from the anesthetic that was injected, and will wear off within a few hours. The steroid that was injected will normally start taking effect in 3 to 5 days. When it does, pain relief can last anywhere from several days to one or two months, or sometimes longer.

If, after the first injection, there is very little relief or it only lasts a few hours, that does not necessarily indicate that the block is an ineffective treatment for that individual. Some patients need a second injection or even a series of injections before their symptoms are fully-relieved and to achieve long-lasting results. This is why, if a week or two has passed and the symptoms are not better, we generally recommend a second injection. There is a cumulative effect with nerve blocks.

To maintain pain relief, patients can have additional therapeutic blocks in the future, when their symptoms return. However, we generally recommend no more than three nerve blocks in a six-month period. Any more that that, and there could be an adverse reaction to the steroid medication that was injected.

Find out if you are a candidate

If you suffer from chronic headaches or occipital neuralgia and you’ve tried conventional pain relievers with no success, an occipital or supraorbital nerve block might be the solution you’ve been looking for. Please call Advanced Pain Consultants at (919) 510-7901 to schedule your consultation with Dr. Pasi. She will be able to determine if you are a candidate for either of these procedures and address any questions or concerns you may have. While nerve blocks aren’t for everyone, they can provide significant and effective pain relief for many people.

A Holistic Approach to Pain Management