• Matthew J Pingree, Joshua S Sole, Travis G Oʼ Brien, Jason S Eldrige, and Susan M Moeschler.
• From the Departments of *Physical Medicine and Rehabilitation and †Anesthesiology, Mayo Clinic, Rochester, MN; and ‡Departments of Neurosciences and Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD.
• Reg Anesth Pain Med. 2017 Jan 1; 42 (1): 99-104.

Background And ObjectivesThe purpose of this prospective open-label study was to investigate the analgesic effects of an ultrasound-guided greater occipital nerve (GON) block at the level of C2, as the nerve courses superficially to the obliquus capitis inferior muscle.MethodsPatients with a diagnosis of occipital neuralgia or cervicogenic headache were recruited for the study. Ultrasound-guided GON blocks at the level of C2 were performed by experienced clinicians according to a standardized protocol. Numeric rating scale pain scores were recorded preinjection and at 30 minutes, 2 weeks, and 4 weeks after injection.ResultsA total of 14 injections were performed with a mean procedure time of 3.75 minutes. Anesthesia in the GON distribution was achieved for 86% of patients at 30 minutes postinjection. Compared with baseline, numeric rating scale scores decreased by a mean of 3.78 at 30 minutes (P < 0.001), 2.64 at 2 weeks (P = 0.006), and 2.21 at 4 weeks (P = 0.01). There were no significant adverse events reported during the study period.ConclusionsThis prospective open-label study demonstrated successful blockade of the GON at the level of C2 using a novel ultrasound-guided technique. Significant reductions in pain scores were observed over the 4-week study period, and no adverse events were reported. The observations from this study provide important preliminary data for future randomized trials involving patients with occipital neuralgia and cervicogenic headache.

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