Abstract
Blocks of the greater occipital nerve (GON) have been performed without target visualization for a long time, based on surface landmarks only. An ultrasound (US)-guided technique was first introduced by our group in 2010 [1]. GON blocks are effective not only in the treatment of occipital neuralgia, which is a relatively rare pathology, but also for other types of headache and even facial pain. Studies confirm pain relief in migraine [2, 3], cervicogenic headache [4], cluster headache [5, 6], and even post-dural puncture headache [7] but show no improvement in chronic tension-type headache [8]. Additionally, they can have a positive effect in trigeminal neuralgia but show no benefit in persistent idiopathic facial pain [9]. Convergence of cervical and trigeminal input seems to be the explanation for this phenomenon, as experimental stimulation of the GON increases metabolic activity both in the trigeminal caudal nucleus and in the cervical dorsal horn [10]. Because of their wide field of indications, GON blocks are performed frequently by pain physicians.
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