Complications of Occipital Nerve Block

Occipital neuralgia is characterized by severe pain localized in the posterior head up to the vertex with occasional radiation to the auricle. The pain is typically one-sided but can be bilateral. Treatment modalities include noninvasive options such as physical therapy and pharmacological management. Despite these measures, patients report moderate to severe pain. Intervention for the treatment of occipital neuralgia is an occipital nerve block. Occipital nerve blocks are also used in the treatment of acute and prophylactic migraines, cervicogenic headache, cluster headache, and post-traumatic headaches. Occipital nerve blocks are considered safe but rarely can be associated with complications. Among the complications are cutaneous adverse reactions, myonecrosis, intra-arterial injections leading to local anesthetic systemic toxicity, and subarachnoid injections that culminate in brain stem anesthesia.