Occipital nerve block is typically the first invasive modality used in occipital neuralgia. When it fails to deliver even temporary pain relief, a defined next-line approach guides further management.
Occipital nerve block using a local anesthetic (lignocaine or bupivacaine), with or without a steroid co-injection, was the prior intervention. This protocol applies when that block did not achieve temporary relief of occipital pain.
After nerve block failure, the protocol moves to minimally invasive, reversible procedures directed at the culprit occipital nerve. These approaches aim to modulate nerve function without permanent nerve destruction. The specific procedural options, their sequencing, and the criteria for selecting among them are contained in the full protocol.
The benchmark for a meaningful response is at least 50% reduction in occipital pain, which also informs decisions about escalation within the procedural pathway.