Occipital Nerve Blocks Cut Migraine Days in Review of 12 Studies

For people whose migraine keeps coming back, an injection at the back of the head may be worth discussing with a clinician. A new analysis that pooled 12 studies and 658 patients found that ultrasound-guided greater occipital nerve blocks were linked with lower pain scores and fewer headache days each month.

The review also asked whether the exact injection spot matters. Injections at a proximal site appeared to cut headache days more than distal ones, but they came with higher rates of some side effects, such as dizziness, and the authors say this comparison still needs direct trials.

What an ultrasound-guided occipital nerve block involves

The greater occipital nerve is one of the nerves that carries feeling from the back of the head. A nerve block is an injection placed close to a nerve, and using ultrasound lets the clinician watch the needle and nearby tissue on a screen as it happens. Researchers often shorten the procedure to US-GONB.

The nerve can be reached at different points along its path. In general terms, a proximal injection is given closer to where the nerve starts in the upper neck, while a distal injection is given farther along, toward the scalp. The review described here compared results from these two approaches.

Pooled results: less pain, fewer headache days and less medication

The research team searched four databases, PubMed, Scopus, Web of Science and the Cochrane Library, for studies published through July 2025. They found 12 studies involving 658 patients with migraine. The data were combined using a random-effects model, a statistical method that allows for differences between studies, and then broken down by where the injection was given.

Across the studies, the block was associated with pain scores an average of 3.48 points lower and 9.12 fewer headache days per month. Headache duration dropped by a mean of 18.98 hours, and monthly use of pain-relief medicine fell by a mean of 10.01.

The authors concluded that the procedure seems both safe and effective for migraine and meaningfully lightens pain and overall headache burden. These figures are averages across varied studies, so any one person's experience could differ considerably.

Injection site: a possible difference in headache days, not in pain

When the team split the results by injection site, pain intensity did not differ significantly between proximal and distal approaches. Headache frequency was another matter. The proximal group averaged 10.83 fewer headache days per month, compared with 6.36 fewer days in the distal group (p = 0.006).

The authors are cautious about this result. It comes from comparing subgroups drawn from separate studies rather than from trials that tested both sites side by side, and they call for new comparative trials. Factors other than the injection site, such as differences in patients or study methods, could partly explain the gap.

Side effects were mostly mild, but the pattern differed by site

Overall, side effects tended to be mild and to pass quickly. Some were more common with one approach than the other, as the figures below show.

Numbness to a pinprick may partly reflect the block reaching the nerve as intended, though the summary does not say how the authors viewed it. Because the figures are given as percentages of injections, it is not clear from the abstract how many individual patients were affected.

• Loss of pinprick sensation (numbness to a light pin touch): 80% of proximal and 100% of distal injections.
• Dizziness: 22.7% with proximal vs. 3.9% with distal injections.
• Moderate-to-severe migraine attacks: 20.1% vs. 12.9%.
• Cerebellar-like symptoms, which can involve balance or coordination: 12.5% vs. 0%.
• Vasovagal syncope, a brief faint linked to a sudden drop in heart rate and blood pressure (9.1%), and local pain (8.1%) appeared only after proximal injections.

What the evidence does and does not show

A pooled analysis can give a broader picture than any single study, but it is only as strong as the studies inside it. These notes come from the published abstract alone, which does not describe how the included studies were designed, whether patients were compared with a sham (fake) procedure, placebo or another treatment, how long they were followed or who paid for the work.

The abstract also does not report the quality of the studies or how much their results varied. Without that, it is hard to judge how much confidence to place in the size of the benefits. The proximal-versus-distal finding rests on indirect comparisons, so it may be best seen as a lead for future research rather than a settled answer.

Several questions remain open. It is not yet known how long relief lasts after a block, whether head-to-head trials would confirm an edge for proximal injections, or how the results would compare against sham treatment.

What this may mean for people living with migraine

For people with frequent migraine, these findings could add to conversations about procedures that may sit alongside other care. In this review, the block was linked with fewer headache days and less use of pain medicine, which may interest people concerned about relying heavily on painkillers.

Still, a nerve block is a medical procedure with possible side effects, and the right approach depends on your headache pattern, health history and current treatments. If migraine is disrupting work, sleep or family life, or if your headaches are changing, a qualified clinician can help you weigh the options.

Pain specialists, such as those at SEVA Healthcare clinics in Tulsa, Dallas and New Mexico, evaluate headache and migraine conditions and can talk through whether a procedure like this is worth considering. Decisions about your own care are best made with a clinician who knows your history.

Frequently asked questions

What is an ultrasound-guided greater occipital nerve block?

It is an injection placed near the greater occipital nerve at the back of the head, with ultrasound used so the clinician can see the needle and surrounding tissue. In this review, it was studied as a treatment for migraine.

How much did the blocks help in this review?

On average, pain scores were 3.48 points lower and patients had 9.12 fewer headache days per month. Headache duration fell by a mean of 18.98 hours and monthly pain-medicine use by a mean of 10.01. These are averages, and how long benefits last was not reported.

Is a proximal or a distal injection better?

Pain relief did not differ significantly between the two sites. Proximal injections showed a larger drop in headache days, 10.83 versus 6.36 days per month, but this comes from indirect comparisons and the authors say direct trials are needed.

What side effects were reported?

Side effects were mostly mild and short-lived. Dizziness, migraine attacks and cerebellar-like symptoms were more common with proximal injections, and fainting and local pain were seen only with proximal injections. A clinician can explain what risks may apply to you.

Sources

• Exploring Proximal and Distal Ultrasound-Guided Greater Occipital Nerve Block Approaches in Migraine: A Systematic Review and Meta-Analysis. — Pain practice : the official journal of World Institute of Pain, 2026-11-01
• Study DOI: 10.1111/papr.70202

This article is sponsored content by SEVA and is for general information only — it is not medical or legal advice. Treatment options depend on an individual evaluation, and results vary from person to person. In an emergency, call 911. Spotted an error? See our corrections policy.