Greater occipital nerve block- A case report of a patient of Occipital neuralgia using proximal approach under USG guidance

• Published in: Indian Journal of Pain Vol. 34; no. 3; pp. 212 - 214
• Main Authors: Tyagi, Vikas, Bibra, Dhruv, Dureja, G
• Format: Journal Article
• Language: English
• Published: Medknow Publications and Media Pvt. Ltd 01.09.2020; Wolters Kluwer Medknow Publications
• Subjects: Bupivacaine; Care and treatment; Diagnosis; Etoricoxib; greater occipital nerve; Neuralgia; obliquus capitis inferior muscle; occipital neuralgia; Tizanidine; ultrasound guidance
• ISSN: 0970-5333
• DOI: 10.4103/ijpn.ijpn_10_20

Occipital neuralgia is a neuropathic pain disorder with distinctive diagnostic and therapeutic challenges. Many pain physicians and neurologists consider this to be a nonexistent condition which merely represents a variant of cervicogenic headache emanating from C1 to C4 nerve roots. Repetitive microtrauma from a hyperextended neck (painting ceilings or working with computers for long hours with a high focal point) may result in the development of this condition. Failure of conservative management necessitates greater occipital nerve (GON) block in the treatment of occipital neuralgia. Conventionally, GON has been blocked at superior nuchal line through a landmark-guided technique using occipital artery pulsations as guidance or using ultrasound as done in classical distal technique at the same site. Another less frequently used technique under ultrasound is the one where the nerve is blocked at a proximal site. We describe here a case report where we chose proximal technique done under ultrasound, superficial to the obliquus capitis inferior muscle (OCIM), which has a higher success rate and allows for a more precise blockade of the nerve before it branches out as in distal technique.