Modal Pain Management · Dr. Alex Movshis, MD
After an Occipital Nerve Block: Side Effects, Worse Headache, and How Long It Lasts
Questions or problems, any hour: (646) 290-6660. Emergency: call 911 or go to the nearest emergency room.
Full guide:modalpain.com/aftercare/
occipital-nerve-block/
At a glance
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Right after the block
- Numbness of the back of the scalp is expected. It shows the numbing medicine reached the nerve.
- If you feel dizzy or light-headed, sit until it passes. Do not drive until it has.
- Go back to your normal day. There is no bed rest and no special position.
- Keep taking your usual headache and preventive medicines unless we changed them.
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The rest of the day
- A shower and hair wash are fine. Pat the injection sites dry.
- The injection sites can be tender. Ice for 10 to 15 minutes helps.
- If the headache comes back as the numbness fades, treat it the way you normally would.
- If you were also given a steroid through an IV for a severe headache, and you have diabetes, check your blood sugar more often for the next day or two.
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The next 2 days
- Scalp numbness usually fades within hours, and occasionally lasts up to 2 days.
- Back to exercise and work as you feel able. There are no restrictions.
- Restart any blood thinner on the plan we made with you before the block.
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The weeks after
- Write down your headache days and how bad each one was. That record is how we judge the block.
- Headaches more frequent or worse than your usual after the first week? Book an earlier follow-up rather than waiting.
- Bring the record to your follow-up visit, usually 2 to 4 weeks after the block.
Call 911 or go to the nearest emergency room for
- Sudden weakness or drooping of one side of the face, trouble speaking, confusion, or fainting
- Double vision, slurred speech, or being unable to walk steadily
- A sudden, severe headache unlike your usual ones, or a seizure
- Fever with a stiff neck, or swelling at the back of the head or neck that is spreading
- Trouble breathing, swelling of the lips or throat, or hives spreading over the body
Call us at (646) 290-6660, day or night, for
- Dizziness or unsteadiness that has not settled by the next morning
- Scalp numbness that lasts more than 2 days
- Redness, warmth, swelling or drainage at an injection site
- Any question about your blood thinner plan
The back of your head is numb, and for the first time in days the headache has gone quiet. That numbness is the point: it shows the medicine reached the nerve. What happens over the next few hours and weeks is what tells us whether the occipital nerves are part of your headache problem.
These are the instructions Dr. Alex Movshis gives after a greater or lesser occipital nerve block at Modal Pain Management. If your block was done elsewhere, most of this still applies, but follow your own physician’s discharge instructions where they differ.
The first hours
The greater occipital nerve carries feeling from most of the back of the scalp, and the lesser occipital nerve from the area behind the ear. The block places a small amount of numbing medicine (local anesthetic) beside one or both. At Modal Pain Management that is usually all it contains, without a steroid, for a reason explained below.
Numbness. Expect the back of the scalp on the injected side to feel numb or thick. The expert consensus on headache nerve blocks treats this numbness as the sign that the block was technically successful (Blumenfeld 2013). It usually fades within hours. In one trial it lasted up to 48 hours in 4 of 51 patients (Friedman 2020).
Relief. When it comes, it often comes fast. In a randomized trial in chronic migraine, where patients had occipital nerve blocks together with trigger point injections, headache severity had fallen by about 3 points out of 10 twenty minutes later (Ashkenazi 2008). Not everyone gets that early drop, and a block can still help over the following weeks without it.
Dizziness. A few people feel light-headed in the minutes to hours after the block. Sit until it passes, and do not drive until it has completely gone. In the trial above it affected 4 of 51 patients (Friedman 2020).
Side effects, and how often they happen
Most side effects are mild. In the randomized trial that compared bupivacaine occipital nerve blocks with an intravenous migraine medicine in the emergency department, 31% of block patients and 38% of the comparison group reported some side effect. In the block group, that meant dizziness in 4 of 51, a worse or changed headache in 3, scalp numbness lasting up to 48 hours in 4, a reaction at the injection site in 2, and stomach upset in 2 (Friedman 2020). Across 16 randomized trials with 930 patients, there were no serious adverse effects (Atraszkiewicz 2025).
Rarer problems are known from single case reports. In one, complete weakness of one side of the face began minutes after the block, most likely because the medicine spread to the facial nerve, and it wore off within 4 to 5 hours (Strauss 2014). In another, an abscess and an infection of the bone at the back of the skull appeared 16 days after the block (Christie 2018). These are the reasons facial weakness, and fever with a stiff neck or spreading swelling, are on the emergency list on this page. Do not assume facial weakness is from the block. Treat it as an emergency.
If your block included a steroid. Some practices add one. Blocks with a steroid can rarely leave a small patch of hair loss or a dent in the skin over the injection site, which has been reported with both methylprednisolone and triamcinolone (Shields 2004, Lambru 2012). In migraine, adding the steroid did not improve any outcome in a randomized trial (Ashkenazi 2008), which is why we usually use the numbing medicine alone.
When the headache comes back, or feels worse
Many people search for this after a block, so here is what the trials show. In the emergency department trial, 3 of 51 patients had a worse or changed headache after the block, against 2 of 48 after the intravenous migraine medicine (Friedman 2020). The rates were similar, and no study has measured a true rebound when the numbing medicine wears off.
Most of the time, a headache after a block is the headache disorder continuing, not something the block caused. Treat it with your usual medicines. Keep a record of headache days so the overall pattern is clear at your follow-up. If headaches are more frequent or worse than your usual after the first week, book an earlier follow-up rather than waiting. A sudden, severe headache unlike your usual ones is different, and it needs an emergency room.
How long relief lasts
It varies widely, and it is not the same as how long the numbing medicine lasts. The best evidence is in chronic migraine. A single bupivacaine block reduced headache days in the week that followed compared with a sham injection (Cuadrado 2017). In a small ultrasound-guided trial, pain kept improving through 4 weeks after one block, while the sham group was nearly back to where it started by then (Palamar 2015). In a multicenter trial, four weekly blocks cut headache days from about 18 a month to about 9 (Inan 2015), and in another, a course of four weekly blocks kept headache days down for 3 months while the sham group’s benefit faded after the first month (Gul 2017).
The block does not help everyone, and the overall evidence is more limited than its popularity suggests. A 2025 review rated the benefit in chronic migraine as low certainty and found that how long it lasts remains unclear (Atraszkiewicz 2025). In the emergency department trial, only 22% of block patients had their headache stay mild or gone for 48 hours, against 38% with the intravenous medicine (Friedman 2020). Your headache record is how we tell which group you are in.
How often a block can be repeated depends on how long it helps and on your insurance plan’s policy. We check your plan before scheduling a repeat.
Driving, work, showering and exercise
No study has tested activity rules after an occipital nerve block, so there are none beyond common sense. No sedation is used, and most people drive themselves home once any dizziness has passed. Go back to work, shower and wash your hair the same day. Exercise as you feel able. Ice for 10 to 15 minutes helps a tender injection site.
Blood thinners. The multisociety guideline places peripheral nerve blocks in the low bleeding-risk group, and treats people with a higher bleeding risk more cautiously (Narouze 2018). Follow the plan we made with you before the block. If you are not sure when to take the next dose, call before you take it.
When to go to the emergency room
Serious problems are rare. Sudden weakness or drooping of one side of the face, trouble speaking, confusion, fainting, a sudden severe headache unlike your usual ones, a seizure, or fever with a stiff neck are emergencies. Call 911 or go to the nearest emergency room, and tell the team you had an occipital nerve block and on what date.
After the result
Dr. Movshis reviews your headache record with you at the follow-up visit, usually 2 to 4 weeks after the block. Good relief that wears off points toward repeating the block on a schedule. No relief points toward a different driver, and the routes below are where we usually look next. The occipital nerve block page explains who the block is for and how it is done.
Frequently asked questions
The common ones are numbness of the back of the scalp, which is expected, tenderness at the injection sites, and brief dizziness. In a randomized trial of bupivacaine occipital nerve blocks, 16 of 51 patients reported any side effect: dizziness in 4, a worse or changed headache in 3, scalp numbness lasting up to 48 hours in 4, and a reaction at the injection site in 2 (Friedman 2020). A 2025 systematic review of 16 randomized trials (930 patients) found no serious adverse effects (Atraszkiewicz 2025). Serious problems such as facial weakness or infection are rare enough to appear only as case reports (Strauss 2014, Christie 2018).
Usually because the numbing medicine has worn off and the headache disorder is doing what it did before, not because the block caused harm. In the trial above, 3 of 51 patients had a worse or changed headache after the block and 2 of 48 after an intravenous migraine medicine, a similar rate (Friedman 2020). Treat it the way you normally would. If headaches are more frequent or worse than your usual a week later, book an earlier follow-up. A sudden, severe headache unlike your usual ones is an emergency.
The numbing medicine works within minutes. In one trial, where the blocks were combined with trigger point injections, headache severity had dropped by about 3 points out of 10 twenty minutes later (Ashkenazi 2008). How long it lasts varies. In chronic migraine, a single bupivacaine block reduced headache days over the following week (Cuadrado 2017), and in a small trial the benefit kept growing for 4 weeks while the sham group drifted back after 2 (Palamar 2015). A course of four weekly blocks kept headache days down for up to 3 months (Gul 2017). Some people get days, some get months.
Usually yes. No sedation is used. Dizziness is the one side effect that matters for driving, and it affected 4 of 51 patients in a randomized trial (Friedman 2020). Wait until any dizziness or unsteadiness has completely passed before you drive. If it has not settled by the next morning, call us.
Yes. Numbness over the area the nerve supplies is the sign that the block reached the nerve, and the expert consensus on headache nerve blocks uses it as the marker of a technically successful block (Blumenfeld 2013). It usually fades within hours. In one trial it lasted up to 48 hours in 4 of 51 patients (Friedman 2020). Numbness lasting longer than 2 days needs a call.
In migraine, the evidence says no. A small randomized trial of 37 patients, in which blocks were combined with trigger point injections, found that adding triamcinolone to the numbing medicine made no difference to any outcome (Ashkenazi 2008), and the placebo-controlled trials in chronic migraine used bupivacaine alone (Inan 2015, Gul 2017). At Modal Pain Management, occipital nerve blocks usually contain a numbing medicine only. Blocks that include a steroid can rarely leave a small patch of hair loss or a dent in the skin at the injection site (Shields 2004, Lambru 2012).
Usually, yes. The multisociety guideline on blood thinners places peripheral nerve blocks in the low bleeding-risk group, where stopping a blood thinner is often not needed. People with a higher bleeding risk are treated with more caution (Narouze 2018). We make the plan with you before the procedure. Do not stop or change a blood thinner on your own.
References
Every figure on this page comes from the sources below. Where no study exists, the page says so and explains the reasoning instead.
- Friedman BW, Irizarry E, Williams A, et al. A randomized, double-dummy, emergency department-based study of greater occipital nerve block with bupivacaine vs intravenous metoclopramide for treatment of migraine. Headache. 2020. doi:10.1111/head.13961 · PubMed
- Atraszkiewicz D, Ünal E, Bassett P, et al. Greater occipital nerve block for the treatment of migraine: an umbrella review, systematic review, and meta-analysis. Cephalalgia. 2025. doi:10.1177/03331024251398390 · PubMed
- Ashkenazi A, Matro R, Shaw JW, et al. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry. 2008. doi:10.1136/jnnp.2007.124420 · PubMed
- Cuadrado ML, Aledo-Serrano Á, Navarro P, et al. Short-term effects of greater occipital nerve blocks in chronic migraine: a double-blind, randomised, placebo-controlled clinical trial. Cephalalgia. 2017. doi:10.1177/0333102416655159 · PubMed
- Palamar D, Uluduz D, Saip S, et al. Ultrasound-guided greater occipital nerve block: an efficient technique in chronic refractory migraine without aura? Pain Physician. 2015. · PubMed
- Gul HL, Ozon AO, Karadas O, et al. The efficacy of greater occipital nerve blockade in chronic migraine: a placebo-controlled study. Acta Neurol Scand. 2017. doi:10.1111/ane.12716 · PubMed
- Inan LE, Inan N, Karadaş Ö, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand. 2015. doi:10.1111/ane.12393 · PubMed
- Blumenfeld A, Ashkenazi A, Napchan U, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches: a narrative review. Headache. 2013. doi:10.1111/head.12053 · PubMed
- Strauss L, Loder E, Rizzoli P. Transient facial nerve palsy after occipital nerve block: a case report. Headache. 2014. doi:10.1111/head.12403 · PubMed
- Christie SD, Kureshi N, Beauprie I, et al. Occipital osteomyelitis and epidural abscess after occipital nerve block: a case report. Can J Pain. 2018. doi:10.1080/24740527.2017.1360725 · PubMed
- Shields KG, Levy MJ, Goadsby PJ. Alopecia and cutaneous atrophy after greater occipital nerve infiltration with corticosteroid. Neurology. 2004. doi:10.1212/01.wnl.0000145832.26051.3c · PubMed
- Lambru G, Lagrata S, Matharu MS. Cutaneous atrophy and alopecia after greater occipital nerve injection using triamcinolone. Headache. 2012. doi:10.1111/j.1526-4610.2012.02270.x · PubMed
- Narouze S, Benzon HT, Provenzano D, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018. doi:10.1097/AAP.0000000000000700 · PubMed
These are general instructions after a occipital nerve block. If the instructions you were given at discharge differ, follow the ones you were given, because they account for your medications and your procedure. For anything you are unsure about, call (646) 290-6660. See the occipital nerve block page for how the procedure works and who it helps, or the aftercare instructions for other procedures.